title: Second-look endoscopy is not associated with better clinical outcomes after gastric endoscopic submucosal dissection: a prospective, randomized, clinical trial analyzed on an as-treated basis.
abstract: BACKGROUND
  The efficacy of routine second-look endoscopy (SLE) to detect or prevent bleeding after gastric endoscopic submucosal dissection (ESD) has not yet been validated.
  
  
  OBJECTIVE
  The aim of this study was to determine whether SLE affects clinical outcomes including bleeding and morbidity after gastric ESD.
  
  
  METHODS
  A prospective, randomized, controlled study with consecutive data analyzed on an as-treated basis.
  
  
  METHODS
  A single, tertiary-care referral center.
  
  
  METHODS
  A total of 182 patients.
  
  
  METHODS
  Gastric ESD and SLE.
  
  
  METHODS
  Incidence of and risk factors related to bleeding after ESD and outcomes by univariate or multivariate analysis.
  
  
  RESULTS
  Among 182 patients enrolled, 74 and 81 patients were assigned to the SLE and no-SLE groups, respectively. Two groups were observed closely for 4 weeks. Bleeding occurred after ESD in 21 patients (13.5%). Hemoglobin loss (≥2.0 g/dL) was observed in 20 patients, and melena developed in 1 patient after ESD. However, only 1 patient needed a transfusion. Twelve patients (16.2%) in the SLE group and 9 in the no-SLE group (11.1%) experienced bleeding after ESD. The frequency of bleeding after ESD was not significantly different between the 2 groups (P = .66). There were no risk factors related to bleeding after ESD.
  
  
  CONCLUSIONS
  Single-center analysis.
  
  
  CONCLUSIONS
  SLE is not routinely necessary because it does not affect clinical outcomes, including bleeding and morbidity after ESD. (
  
  
  BACKGROUND
  KCT0000146.).
authors.affiliation: Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
authors.forename: Ho Yoel
authors.initials: HY
authors.lastname: Ryu
authors.forename: Jae Woo
authors.initials: JW
authors.lastname: Kim
authors.forename: Hyun-Soo
authors.initials: HS
authors.lastname: Kim
authors.forename: Hong Jun
authors.initials: HJ
authors.lastname: Park
authors.forename: Hyo Keun
authors.initials: HK
authors.lastname: Jeon
authors.forename: So Yeon
authors.initials: SY
authors.lastname: Park
authors.forename: Bo Ra
authors.initials: BR
authors.lastname: Kim
authors.forename: Cui Cui
authors.initials: CC
authors.lastname: Lang
authors.forename: Sung Ho
authors.initials: SH
authors.lastname: Won
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000368:Aged; D004210:Dissection / Q000379:methods; D005260:Female; D005753:Gastric Mucosa / Q000601:surgery*; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000175:diagnosis* / Q000517:prevention & control; D024162:Second-Look Surgery / Q000379:methods*; D013274:Stomach Neoplasms / Q000601:surgery*; D062606:Tertiary Care Centers; D016896:Treatment Outcome
keywords: APC; ESD; PT; SLE; aPTT; activated partial thromboplastin time; argon plasma coagulation; endoscopic submucosal dissection; prothrombin time; second-look endoscopy