Second-Look Endoscopy after Gastric Endoscopic Submucosal Dissection for Reducing Delayed Postoperative Bleeding

Abstract

Background/AimsThis stuy evaluated the role of a second-look endoscopy after gastric endoscopic submucosal dissection in patients without signs of bleeding.MethodsBetween March 2011 and March 2012, 407 patients with gastric neoplasms who underwent endoscopic submucosal dissection for 445 lesions were retrospectively reviewed. After the patients had undergone endoscopic submucosal dissection, they were allocated to two groups (with or without second-look endoscopy) according to the following endoscopy. The postoperative bleeding risk of the lesions was not considered when allocating the patients.ResultsThe delayed postoperative bleeding rates did not differ between the two groups (with vs without second-look endoscopy, 3.0% vs 2.1%; p=0.546). However, a tumor in the upper-third of the stomach (odds ratio [OR], 5.353; 95% confidence interval [CI], 1.075 to 26.650) and specimen size greater than 40 mm (OR, 4.794; 95% CI, 1.307 to 17.588) were both independent risk factors for delayed postoperative bleeding. Additionally, second-look endoscopy was not related to reduced delayed postoperative bleeding. However, delayed postoperative bleeding in the patients who did not undergo a second-look endoscopy occurred significantly earlier than that in patients who underwent a second-look endoscopy (4.5 and 14.0 days, respectively, p=0.022).ConclusionsA routine second-look endoscopy after gastric endoscopic submucosal dissection is not necessary for all patients.

Risk factors for bleeding after gastric endoscopic submucosal dissection: a systematic review and meta-analysis

“…42 PPB rates were similar between genders in most studies, [13][14][15][16][17][18][20][21][22][23][25][26][27][28][29][30][31][32][33][34]36,39,[42][43][44] with only 1 study reporting an association male sex associated with PPB. 24 Arterial hypertension was not identified as a risk factor in most studies, [13][14][15]17,18,[20][21][22][23][24][28][29][30][31]33,42,43,45 although 2 studies reported significantly higher PPB rates in hypertensive patients. 16,36 However, the adjusted OR was .67 in the latter study.…”

“…Chronic kidney disease was not identified as a risk factor in some studies despite a trend to higher bleeding. 14,17,22,28,30,34,42 However, 3 studies found significantly increased PPB rates in patients with chronic kidney disease 45 and undergoing dialysis. 18,46 Comorbidities 28, 45 and American Society of Anesthesiologists Physical Status Classification System status 47 were not identified to be associated with PPB, although 1 study found increased PPB risk in patients with significant comorbidities.…”

“…36 Similarly, diabetes mellitus was not identified as a significant risk factor in any study. [13][14][15][16][17][18][20][21][22][23][24][28][29][30][31]33,34,36,42,44,45 Cardiopathy (ischemic heart disease in most studies), 10 were not identified as risk factors for PPB in most studies. Chronic kidney disease was not identified as a risk factor in some studies despite a trend to higher bleeding.…”

“…34 Furthermore, 10 studies found no significant differences in elderly patients, 19,25,30,[35][36][37][38][39][40][41] although 1 study identified age > 80 years as an independent risk factor for PPB. 42 PPB rates were similar between genders in most studies, [13][14][15][16][17][18][20][21][22][23][25][26][27][28][29][30][31][32][33][34]36,39,[42][43][44] with only 1 study reporting an association male sex associated with PPB. 24 Arterial hypertension was not identified as a risk factor in most studies, [13][14][15]17,18,[20][21][22][23][24][28]…”

“…13,14,[16][17][18][20][21][22][23][27][28][29][30][31]36,42,43 However, meta-analysis showed that PPB was significantly associated with AT use (Fig. 3).…”