title: Delayed bleeding and hemorrhage of mucosal defects after gastric endoscopic submucosal dissection on second-look endoscopy.
abstract: BACKGROUND
  Although second-look endoscopy is performed within several days after gastric endoscopic submucosal dissection (ESD), there has been no evidence supporting the usefulness of the intervention. We investigated the relationship between delayed bleeding and hemorrhage of mucosal defects after ESD on second-look endoscopy and analyzed risk factors of active bleeding on second-look endoscopy.
  
  
  METHODS
  A total of 441 consecutive ESD cases with gastric cancer or adenoma were retrospectively analyzed. Second-look endoscopy was performed in the morning after the day of ESD. Bleeding of mucosal defects on second-look endoscopy was classified according to the Forrest classification, and active bleeding was defined as Forrest Ia or Ib. Delayed bleeding was defined as hematemesis or melena after second-look endoscopy.
  
  
  RESULTS
  A total of 406 second-look endoscopies were performed, and delayed bleeding occurred in 11 patients. The incidence rate of delayed bleeding after second-look endoscopy in patients with Forrest Ia or Ib was significantly higher than that in patients with Forrest IIa, IIb or III (7.69 vs. 2.02 %, p < 0.05). Complication of a histological ulcer, large size of the resected specimen and long ESD procedure time were shown to be risk factors for hemorrhage of mucosal defects after ESD on second-look endoscopy by univariate analysis. Multivariate analysis indicated that only large size of the resected specimen was a risk factor. In a specimen size of >35 mm, the odds ratio of active bleeding on second-look endoscopy was 1.9.
  
  
  CONCLUSIONS
  Active bleeding of mucosal defects on second-look endoscopy is a risk factor for delayed bleeding.
authors.affiliation: Division of Endoscopy, Hokkaido University Hospital, Nishi-7, Kita-15, Kita-ku, Sapporo, 060-8638, Japan. onosho@med.hokudai.ac.jp.
authors.forename: Shoko
authors.initials: S
authors.lastname: Ono
authors.affiliation: Department of Gastroenterology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Ono
authors.affiliation: Division of Endoscopy, Hokkaido University Hospital, Nishi-7, Kita-15, Kita-ku, Sapporo, 060-8638, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Nakagawa
authors.affiliation: Department of Gastroenterology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Shimizu
authors.affiliation: Division of Endoscopy, Hokkaido University Hospital, Nishi-7, Kita-15, Kita-ku, Sapporo, 060-8638, Japan.
authors.forename: Mototsugu
authors.initials: M
authors.lastname: Kato
authors.affiliation: Department of Gastroenterology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Naoya
authors.initials: N
authors.lastname: Sakamoto
mesh_terms: D000236:Adenoma / Q000473:pathology / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D000069916:Endoscopic Mucosal Resection / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery; D005773:Gastroscopy / Q000009:adverse effects / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D024162:Second-Look Surgery / Q000009:adverse effects / Q000379:methods*; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
keywords: Endoscopic gastrointestinal surgery; Gastric cancer; Postoperative hemorrhage