title: Second-look endoscopy with prophylactic hemostasis is still effective after endoscopic submucosal dissection for gastric neoplasm.
abstract: OBJECTIVE
  The clinical value of second-look endoscopy (SLE) after endoscopic submucosal dissection (ESD) has been doubted continuously. The aim of this study was to assess the effectiveness of SLE based on the risk of delayed bleeding after ESD.
  
  
  METHODS
  A total of 310 lesions of gastric epithelial neoplasms treated by ESD were reviewed. The lesions were divided into two groups based on the risk of post-procedural bleeding estimated by Forrest classification. The high risk of rebleeding group (Forrest Ia, Ib and IIa) required endoscopic treatment, while the low risk of rebleeding group (Forrest IIb, IIc and III) did not. Delayed bleeding after ESD was investigated.
  
  
  RESULTS
  Sixty-six lesions were included in the high risk of rebleeding group and 244 lesions in the low risk of rebleeding group. There were no significant differences in delayed bleeding between the high risk group (1/66) and the low risk group (1/244) (P = 0.38). The high risk of rebleeding group tended to be located more often in the mid-third and had higher appearance of flat or depressed shape than the low risk group (P = 0.004 and P = 0.006, respectively).
  
  
  CONCLUSIONS
  SLE with pre-emptive prophylactic endoscopic treatment is still effective in preventing delayed bleeding after ESD.
authors.affiliation: Ji Hye Jung, Beom Jin Kim, Chang Hwan Choi, Jae G Kim, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul 156-755, South Korea.
authors.forename: Ji Hye
authors.initials: JH
authors.lastname: Jung
authors.affiliation: Ji Hye Jung, Beom Jin Kim, Chang Hwan Choi, Jae G Kim, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul 156-755, South Korea.
authors.forename: Beom Jin
authors.initials: BJ
authors.lastname: Kim
authors.affiliation: Ji Hye Jung, Beom Jin Kim, Chang Hwan Choi, Jae G Kim, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul 156-755, South Korea.
authors.forename: Chang Hwan
authors.initials: CH
authors.lastname: Choi
authors.affiliation: Ji Hye Jung, Beom Jin Kim, Chang Hwan Choi, Jae G Kim, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul 156-755, South Korea.
authors.forename: Jae G
authors.initials: JG
authors.lastname: Kim
mesh_terms: D000368:Aged; D004210:Dissection / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods*; D005773:Gastroscopy / Q000009:adverse effects / Q000379:methods*; D006489:Hemostatic Techniques; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies; D012307:Risk Factors; D024162:Second-Look Surgery / Q000009:adverse effects / Q000379:methods*; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Delayed bleeding; Endoscopic submucosal dissection; Forrest classification; Second-look endoscopy