title: Second and third-look endoscopy for the prevention of post-ESD bleeding.
abstract: The efficacy of 2nd-look esophagogastroduodenoscopy (EGD) with endoscopic hemostatic therapy (EHT) for the prevention of postendoscopic submucosal dissection (ESD) clinical bleeding remains controversial. The aim of this study was to estimate post-ESD bleeding rate using 2nd and 3rd-look strategy, and to determine risk factors for clinical bleeding, and for EHT at 2nd and 3rd-look EGDs.Three hundred forty-four consecutive patients with early gastric cancer or adenoma underwent ESD from January 2006 through March 2012. Second and 3rd-look EGDs were performed on day 1 (D1) and day 7 (D7), respectively, with EHT as needed.Post-ESD clinical bleeding rate was 2.6% (95% confidence interval [CI] 1.2%-4.9%). For clinical bleeding, adjusted odds ratios (ORs) for age <65 years and antithrombotic drug uses were 4.40 (95% CI 1.07-19.93) and 7.34 (95% CI 1.80-32.48), respectively. For D1 EHT, adjusted ORs of tumor location in the lower part of the stomach and maximum tumor diameter ≥60 mm were 2.16 (95% CI 1.35-3.51) and 2.20 (95% CI 1.05-4.98), respectively. For D7 EHT, adjusted OR of D1 EHT was 4.65 (95% CI 1.56-20.0).Post-ESD clinical bleeding rate was relatively low using 2nd and 3rd-look strategy. Age <65 years and antithrombotic drug use are significant risk factors for clinical bleeding. Regarding EHT, tumor location in the lower part of the stomach and maximum diameter of resected specimen ≥60 mm are significant predictors for D1 EHT. D1 EHT in turn is a significant risk factor for D7 EHT. The efficacy of sequential strategy for preventing post-ESD bleeding is promising.
authors: From the Department of Endoscopic Medicine, Mie University Hospital (ST, NH, KT, YH, MK); Department of Gastroenterology and Hepatology, Mie University Graduate School of Medicine, Tsu (ST, KN, KN, KN, RY, HI, YT); Department of Internal Medicine, St. Luke's International Hospital, Tokyo (FO); Department of Immunology (ECG); and Department of Hematology and Oncology, Mie University Graduate School of Medicine, Tsu, Mei, Japan (NK).
authors: Shunsuke
authors: S
authors: Tano
authors: Noriyuki
authors: N
authors: Horiki
authors: Fumio
authors: F
authors: Omata
authors: Kyosuke
authors: K
authors: Tanaka
authors: Yasuhiko
authors: Y
authors: Hamada
authors: Masaki
authors: M
authors: Katsurahara
authors: Katsuhito
authors: K
authors: Ninomiya
authors: Kenichiro
authors: K
authors: Nishikawa
authors: Keiichiro
authors: K
authors: Nojiri
authors: Reiko
authors: R
authors: Yamada
authors: Hiroyuki
authors: H
authors: Inoue
authors: Esteban C
authors: EC
authors: Gabazza
authors: Naoyuki
authors: N
authors: Katayama
authors: Yoshiyuki
authors: Y
authors: Takei
mesh_terms: D000367:Age Factors; D000368:Aged; D016145:Endoscopy, Digestive System; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects; D006489:Hemostatic Techniques; D006801:Humans; D008297:Male; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D012307:Risk Factors; D024162:Second-Look Surgery; D013274:Stomach Neoplasms / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents