The role of second-look endoscopy in endoscopic submucosal dissection for early gastric cancer.
OBJECTIVE
Delayed bleeding is a major complication of endoscopic submucosal dissection. Second-look endoscopy is routinely performed in most hospitals to reduce the possibility of delayed bleeding without solid evidence to support this practice. The aim of this study was to evaluate whether second-look endoscopy prevents delayed bleeding, and to verify clinicopathological features of delayed bleeding in order to identify lesions that may benefit from a second-look endoscopy.


METHODS
We investigated 392 lesions in 388 patients who underwent endoscopic submucosal dissection for early gastric cancer from January 2006 to July 2011. Clinically evident bleeding from mucosal defects 24 hours after endoscopic submucosal dissection was considered delayed bleeding. Data including characteristics of patients, lesions, and procedures were reviewed. Furthermore, the rate of delayed bleeding before and after second-look endoscopy, performed within three days of endoscopic submucosal dissection, was investigated to determine the utility of second-look endoscopy.


RESULTS
Delayed bleeding was evident in 12 of 392 lesions (3,1%), all of which achieved endoscopic hemostasis. The only significant factor predicting delayed bleeding was a resected specimen size of over 40 mm (OR=6,200, 95% CI=1,912 - 20,108). Delayed bleeding occurred more frequently prior to the second-look endoscopy (p=0,022).


CONCLUSIONS
In our endoscopic submucosal dissection data about early gastric cancer, it is too early to conclude that second-look endoscopy is not a valuable procedure, and second-look endoscopy may be useful for preventing post-endoscopic submucosal dissection bleeding, especially in resected specimens greater than 40 mm in size.
Kosin University College of Medicine, Department of Gastroenterology, Busan, Republic Of Korea.
Seung Eun
SE
Kim
Hyung Hun
HH
Kim
Joo Hoon
JH
Kim
Jin Young
JY
Lee
Seun Ja
SJ
Park
Moo In
MI
Park
Won
W
Moon
D000368:Aged; D004210:Dissection / Q000009:adverse effects*; D005260:Female; D005753:Gastric Mucosa / Q000601:surgery; D005773:Gastroscopy; D016558:Hemostasis, Endoscopic; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000209:etiology* / Q000517:prevention & control*; D024162:Second-Look Surgery; D013274:Stomach Neoplasms / Q000601:surgery*