title: Clinical outcomes of second-look endoscopy after gastric endoscopic submucosal dissection: predictive factors with high risks of bleeding.
abstract: BACKGROUND
  A second-look endoscopy is routinely performed after endoscopic submucosal dissection (ESD) in many institutions, although the need is questionable. Additional hemostatic procedures might be necessary for the post-ESD ulcer with a high risk of bleeding. We investigated the predictive factors for post-ESD ulcers with a high risk of bleeding.
  
  
  METHODS
  Second-look endoscopy was performed on the day following ESD. The post-ESD ulcers were categorized into two risk groups according to the Forrest classification: high-risk ulcer stigma (type I and IIa) and low-risk ulcer stigma. We analyzed the risk factors associated with high-risk ulcer stigma and late delayed bleeding.
  
  
  RESULTS
  During the study period, 616 ESD procedures were performed. Second-look endoscopy revealed that the incidence of high-risk ulcer stigma post-ESD was 15.1%. Early and late delayed bleeding rates were 3.7 and 1.9%, respectively. Multivariate analysis revealed that submucosal fibrosis and nausea were significantly related to high-risk ulcer stigma after ESD. Multivariate analysis revealed that surface erosion, location of the lesion, and high-risk ulcer stigma identified by second-look endoscopy were significantly associated with late delayed bleeding.
  
  
  CONCLUSIONS
  The effective use of selective second-look endoscopy will help limit unnecessary procedures. Submucosal fibrosis and nausea were risk factors associated with high-risk ulcer stigma after ESD.
authors.affiliation: Department of Internal Medicine, Medical Research Institute, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Beomeo-ri, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, 626-770, Korea, luckyace@hanmail.net.
authors.forename: Cheol Woong
authors.initials: CW
authors.lastname: Choi
authors.forename: Hyung Wook
authors.initials: HW
authors.lastname: Kim
authors.forename: Dae Hwan
authors.initials: DH
authors.lastname: Kang
authors.forename: Yong Mi
authors.initials: YM
authors.lastname: Hong
authors.forename: Su Jin
authors.initials: SJ
authors.lastname: Kim
authors.forename: Su Bum
authors.initials: SB
authors.lastname: Park
authors.forename: Mong
authors.initials: M
authors.lastname: Cho
authors.forename: Dong Jun
authors.initials: DJ
authors.lastname: Kim
authors.forename: Joung Boom
authors.initials: JB
authors.lastname: Hong
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery; D000236:Adenoma / Q000473:pathology / Q000601:surgery; D004210:Dissection; D005260:Female; D005355:Fibrosis; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery*; D005773:Gastroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009325:Nausea / Q000150:complications; D019106:Postoperative Hemorrhage / Q000175:diagnosis*; D012307:Risk Factors; D024162:Second-Look Surgery; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D013276:Stomach Ulcer / Q000473:pathology