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Related Experiment Video

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Second-look endoscopy after gastric endoscopic submucosal dissection for reducing delayed postoperative bleeding.

Chan Hyuk Park1, Jun Chul Park1, Hyuk Lee1

  • 1Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.

Gut and Liver
|August 30, 2014
PubMed
Summary

Routine second-look endoscopy after gastric endoscopic submucosal dissection is not necessary for all patients. While it did not reduce bleeding rates, upper-third stomach tumors and larger specimens were identified as risk factors.

Keywords:
BleedingDelayed bleedingEndoscopic submuco-sal dissectionHemostasisSecond-look endoscopy

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Area of Science:

  • Gastroenterology
  • Endoscopy
  • Surgical Oncology

Background:

  • Gastric endoscopic submucosal dissection (ESD) is a minimally invasive procedure for gastric neoplasms.
  • Postoperative bleeding is a potential complication following ESD.
  • The utility of a second-look endoscopy (SLE) in managing bleeding risk after gastric ESD is debated.

Purpose of the Study:

  • To evaluate the effectiveness of second-look endoscopy in reducing delayed postoperative bleeding after gastric endoscopic submucosal dissection.
  • To identify risk factors for delayed postoperative bleeding in patients undergoing gastric ESD.

Main Methods:

  • Retrospective review of 407 patients with gastric neoplasms undergoing 445 ESD procedures.
  • Patients were divided into two groups: those who underwent SLE and those who did not.
  • Analysis of delayed postoperative bleeding rates and associated risk factors.

Main Results:

  • No significant difference in delayed postoperative bleeding rates between the SLE and no-SLE groups (3.0% vs 2.1%, p=0.546).
  • Tumor location in the upper third of the stomach (OR, 5.353) and specimen size >40 mm (OR, 4.794) were independent risk factors for bleeding.
  • Bleeding occurred significantly earlier in patients who did not undergo SLE (4.5 days) compared to those who did (14.0 days).

Conclusions:

  • Routine second-look endoscopy is not universally necessary after gastric ESD.
  • Risk stratification based on tumor location and specimen size may guide management decisions.
  • Further research may explore selective use of SLE in high-risk patients.