Second and third-look endoscopy for the prevention of post-ESD bleeding

Area of Science:

• Gastroenterology
• Endoscopic Surgery
• Oncology

Background:

• Post-endoscopic submucosal dissection (ESD) bleeding is a significant concern.
• The efficacy of routine second-look esophagogastroduodenoscopy (EGD) with endoscopic hemostatic therapy (EHT) for preventing post-ESD bleeding is debated.

Purpose of the Study:

• To evaluate the post-ESD clinical bleeding rate using a 2nd and 3rd-look EGD strategy.
• To identify risk factors for clinical bleeding after ESD.
• To determine predictors for requiring EHT during 2nd and 3rd-look EGDs.

Main Methods:

• A retrospective study of 344 patients undergoing ESD for early gastric cancer or adenoma.
• Second-look EGD on day 1 (D1) and third-look EGD on day 7 (D7) were performed.
• EHT was administered as needed during these EGDs; risk factors were analyzed using logistic regression.

Main Results:

• The overall post-ESD clinical bleeding rate was 2.6%.
• Risk factors for bleeding included younger age (<65 years) and antithrombotic drug use.
• Predictors for D1 EHT were lower gastric tumor location and larger tumor diameter (≥60 mm); D1 EHT predicted D7 EHT.

Conclusions:

• A sequential 2nd and 3rd-look EGD strategy results in a low post-ESD clinical bleeding rate.
• Age and antithrombotic use are key clinical bleeding risk factors.
• Tumor characteristics influence the need for EHT, and prior EHT increases the likelihood of requiring it later.