title: A multicenter survey of the management after gastric endoscopic submucosal dissection related to postoperative bleeding.
abstract: OBJECTIVE
  Bleeding is a major complication after gastric endoscopic submucosal dissection (ESD). An evidence-based strategy for postoperative care related to delayed bleeding is required. We conducted a multicenter survey to assess the current status of management after gastric ESD.
  
  
  METHODS
  A total of 1,814 gastric epithelial neoplasms in 2009 at ten tertiary referral centers were enrolled. The current status of the management after gastric ESD (use of an antisecretory drug, food intake, and second-look endoscopy) at participating hospitals was assessed. Furthermore, the rate of post-ESD bleeding and the differences in each parameter were retrospectively analyzed.
  
  
  RESULTS
  Postoperative bleeding occurred in 100 cases (5.5%), which included 62 cases of bleeding within 24 h after ESD. In all of the hospitals, proton pump inhibitors (PPIs) were used. The median administration period was 56 days (range 14-60 days). Food intake was resumed from postoperative day (POD) 1 in 4 hospitals and from POD 2 in 6 hospitals. Second-look endoscopy was performed for almost all cases, fewer cases, and rarely or none in 6, 2, and 2 hospitals, respectively. The day of second-look endoscopy varied among hospitals. There was no statistical relationship between the postoperative bleeding rate and the differences in these three parameters.
  
  
  CONCLUSIONS
  Post-ESD management (duration of PPI use, resumption of food intake, and performance of second-look endoscopy) varied among the medical centers; thus, randomized controlled trials are required for an optimal strategy after gastric ESD.
authors: Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan. ogotou-gi@umin.ac.jp
authors: Osamu
authors: O
authors: Goto
authors: Mitsuhiro
authors: M
authors: Fujishiro
authors: Ichiro
authors: I
authors: Oda
authors: Naomi
authors: N
authors: Kakushima
authors: Yorimasa
authors: Y
authors: Yamamoto
authors: Yosuke
authors: Y
authors: Tsuji
authors: Ken
authors: K
authors: Ohata
authors: Takashi
authors: T
authors: Fujiwara
authors: Junko
authors: J
authors: Fujiwara
authors: Naoki
authors: N
authors: Ishii
authors: Chizu
authors: C
authors: Yokoi
authors: Shinichi
authors: S
authors: Miyamoto
authors: Toshiyuki
authors: T
authors: Itoh
authors: Shinji
authors: S
authors: Morishita
authors: Takuji
authors: T
authors: Gotoda
authors: Kazuhiko
authors: K
authors: Koike
mesh_terms: D004210:Dissection / Q000379:methods; D004435:Eating; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D011182:Postoperative Care; D011183:Postoperative Complications / Q000517:prevention & control; D054328:Proton Pump Inhibitors / Q000008:administration & dosage; D024162:Second-Look Surgery / Q000706:statistics & numerical data; D013274:Stomach Neoplasms / Q000601:surgery
chemical_list: D054328:Proton Pump Inhibitors