title: Postprocedural combined treatment using the coagulation plus artery-selective clipping (2C) method for the prevention of delayed bleeding after ESD.
abstract: BACKGROUND
  The incidence of delayed bleeding after endoscopic submucosal dissection (ESD) for gastric neoplasms is reported to be approximately 5 %. We examined whether postprocedural combined treatment using the coagulation plus artery-selective clipping (2C) method is a useful measure for preventing delayed bleeding after ESD.
  
  
  METHODS
  A total of 234 gastric epithelial neoplasms were treated from June 2007 to May 2012. Post-ESD coagulation (PEC) and clipping for part of the vessels was performed for 154 lesions from June 2007 to June 2010. A total of 80 lesions were treated using the 2C method from July 2010 to May 2012. During ESD, the locations of the arteries were recorded on a schematic diagram of the lesion. Arteries were defined as regions of arterial bleeding that required coagulation or apparent arteries in which preventive coagulation was performed. When ESD was completed, soft coagulation was performed for arteries in the resection area using hemostatic forceps, followed by arterial clipping for additional strength. Coagulation also was performed continuously for visible vessels in the resection area. This was a retrospective study. The incidence rates of delayed bleeding after ESD, as evidenced by hematemesis or melena, or the presence of anemia (decline in Hb >2 g/dl) that required emergency endoscopy were recorded.
  
  
  RESULTS
  Delayed bleeding occurred in 7 (4.5 %) of the 154 cases treated using PEC and in 1 (1.3 %) of the 80 cases treated using the 2C method. The mean time required for the 2C method was 15.0 ± 7.0 min (range, 5-44 min). The mean number of clippings per lesion was 3.8 ± 2.8 (range, 0-13). Almost all clips fell off within 2 months of the procedure.
  
  
  CONCLUSIONS
  Coagulation plus artery-selective clipping (the 2C method) of post-ESD ulcers might effectively reduce the incidence of delayed bleeding after ESD for gastric neoplasms.
authors.affiliation: Department of Gastroenterology, Miyoshi Central Hospital, 531 Higashisakeya-chou, Miyoshi, Hiroshima, 728-8502, Japan. sshin.1207@nifty.com
authors.forename: Shinichi
authors.initials: S
authors.lastname: Mukai
authors.forename: Songde
authors.initials: S
authors.lastname: Cho
authors.forename: Shinya
authors.initials: S
authors.lastname: Nakamura
authors.forename: Yu
authors.initials: Y
authors.lastname: Hatano
authors.forename: Takahiro
authors.initials: T
authors.lastname: Kotachi
authors.forename: Akinori
authors.initials: A
authors.lastname: Shimizu
authors.forename: Genta
authors.initials: G
authors.lastname: Matsuura
authors.forename: Takahiro
authors.initials: T
authors.lastname: Azakami
authors.forename: Atsuhisa
authors.initials: A
authors.lastname: Takaba
authors.forename: Toshihide
authors.initials: T
authors.lastname: Hamada
authors.forename: Ken
authors.initials: K
authors.lastname: Hirata
authors.forename: Toshio
authors.initials: T
authors.lastname: Nakanishi
mesh_terms: D000368:Aged; D001158:Arteries; D003131:Combined Modality Therapy; D005260:Female; D005773:Gastroscopy; D006489:Hemostatic Techniques; D006801:Humans; D008297:Male; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D012189:Retrospective Studies; D013270:Stomach / Q000098:blood supply; D013274:Stomach Neoplasms / Q000601:surgery*