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Updated: Mar 28, 2026
Endoscopic Vacuum Therapy for the Treatment of Anastomotic Leakage after Total Gastrectomy with Esophagojejunostomy
Published on: August 22, 2025
Second-look endoscopy with prophylactic hemostasis is still effective after endoscopic submucosal dissection for
Ji Hye Jung1, Beom Jin Kim1, Chang Hwan Choi1
1Ji 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.
Aim:
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).
Conclusion:
SLE with pre-emptive prophylactic endoscopic treatment is still effective in preventing delayed bleeding after ESD.
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