Second-look endoscopy after endoscopic submucosal dissection for gastric neoplasms

Area of Science:

• Gastroenterology
• Endoscopy
• Surgical Oncology

Background:

• Gastric endoscopic submucosal dissection (ESD) is a minimally invasive procedure for early gastric cancer.
• The necessity of routine second-look endoscopy (SLE) following gastric ESD is debated.
• Post-procedural bleeding is a significant complication of gastric ESD.

Purpose of the Study:

• To systematically evaluate the efficacy of second-look endoscopy in preventing post-procedural bleeding after gastric ESD.
• To analyze the impact of SLE on bleeding rates in patients undergoing gastric ESD.
• To determine if SLE offers an advantage in managing patients with large tumors (>20 mm).

Main Methods:

• A systematic review and meta-analysis of randomized controlled trials (RCTs) were conducted.
• Searches were performed in PubMed, Cochrane Library, and Igaku-chuo-zasshi databases.
• Pooled odds ratios (OR) were calculated to assess the risk of post-ESD bleeding.

Main Results:

• Three RCTs involving 854 patients were included.
• The pooled OR for post-ESD bleeding without SLE was 0.69 (95% CI: 0.38-1.26, P=0.228), indicating no significant difference.
• No significant difference in outcomes was observed for large tumor sizes (>20 mm).

Conclusions:

• Second-look endoscopy offers no significant advantage in preventing post-ESD bleeding for patients without a high risk of bleeding.
• The routine use of SLE after gastric ESD is not supported by current evidence for low-risk patients.
• Further research may be needed to identify specific high-risk subgroups that could benefit from SLE.