title: Second-look endoscopy after endoscopic submucosal dissection for gastric neoplasms.
abstract: Routine second-look endoscopy after gastric endoscopic submucosal dissection (ESD) remains controversial. The aim of the present study was to systematically evaluate the efficacy of second-look endoscopy for gastric ESD. PubMed, the Cochrane library, and the Igaku-chuo-zasshi database were searched in order to identify randomized trials eligible for inclusion in the systematic review. Data were combined to calculate a pooled odds ratio (OR) for developing post-ESD bleeding. The database search yielded three randomized trials (854 patients). Compared with second-look endoscopy, the pooled OR for post-ESD bleeding without second-look endoscopy was 0.69 (95% confidence interval [CI]: 0.38-1.26, P = 0.228), without significant heterogeneity. There were no significant differences between second-look endoscopy and no second-look endoscopy with regard to large tumor size (>20 mm). This systematic review and meta-analysis showed that second-look endoscopy had no advantage for the prevention of post-ESD bleeding in patients without a high risk of bleeding.
authors.affiliation: Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Nishizawa
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Suzuki
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kinoshita
authors.forename: Osamu
authors.initials: O
authors.lastname: Goto
authors.forename: Takanori
authors.initials: T
authors.lastname: Kanai
authors.forename: Naohisa
authors.initials: N
authors.lastname: Yahagi
mesh_terms: D018572:Disease-Free Survival; D004210:Dissection / Q000379:methods; D005260:Female; D005753:Gastric Mucosa / Q000601:surgery*; D005773:Gastroscopy / Q000379:methods* / Q000401:mortality; D006801:Humans; D008297:Male; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D024162:Second-Look Surgery / Q000379:methods*; D013274:Stomach Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: bleeding; endoscopic submucosal dissection (ESD); meta-analysis; second-look endoscopy; systematic review