Second-look endoscopy findings after endoscopic submucosal dissection for colorectal epithelial neoplasms

Abstract

Background/Aims: Although second-look endoscopy (SLE) is frequently performed after gastric endoscopic submucosal dissection (ESD) to prevent bleeding, no studies have reported SLE findings after colorectal ESD. This study aimed to investigate SLE findings and their role in preventing delayed bleeding after colorectal ESD. Methods: Post-ESD ulcer appearances were divided into coagulation (with or without remnant minor vessels) and clip closure groups. SLE findings were categorized according to the Forrest classification (high-risk ulcer stigma [type I and IIa] and low-risk ulcer stigma [type IIb, IIc, III, or clip closure]), and risk factors for high-risk ulcer stigma were analyzed. Results: Among the 375 cases investigated, SLEs were performed in 171 (45.6%) patients. The incidences of high-risk ulcer stigma and low-risk stigma were 5.3% (9/171) and 94.7% (162/171), respectively. During SLE, endoscopic hemostasis was performed more frequently in the high-risk ulcer stigma group than in the lowrisk ulcer stigma group (44.4% [4/9] vs. 1.9% [3/162], respectively; p < 0.001), but most of the endoscopic hemostasis in the high-risk ulcer stigma group (3/4, 75.0%) were prophylactic hemostasis. Post-ESD delayed bleeding occurred in three (0.8%) patients belonging to the SLE group, of which, one patient was from the high-risk stigma group and two were from the low-risk stigma group. Conclusions: The incidence of high-risk ulcer stigma during SLE was low, and delayed bleeding occurred in, both, high-risk and low-risk groups of SLE. SLEs performed after colorectal ESD may not be effective in preventing delayed bleeding, and further prospective studies are needed to evaluate the efficacy of SLE in post-colorectal ESD.

Endoscopic submucosal dissection techniques and technology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review

“…Colon Likewise, SLE after colorectal ESD is generally not performed as no supportive evidence exists. Only one recent Korean study has evaluated the value of SLE with prophylactic hemostasis or coagulation of visible vessels following colorectal ESD 189 . The authors concluded that the incidence of high risk ulcer stigma during SLE was low (5.3 %), and that SLE was not effective in preventing delayed bleeding – the three PPB cases (0.8 %) occurred in the SLE group, one in a patient with high risk stigma on SLE and two in patients with low risk ulcer stigma.…”

Short‐term outcomes of patients undergoing endoscopic submucosal dissection for colorectal lesions

“…The use of antithrombotic agents and the presence of rectal lesions were both predictors for developing severe adverse events (grade ≥ III) which were all delayed bleeding. In previous studies, 30–32 these two factors were also identified as risk factors for the development of delayed bleeding after colorectal ESD. In our most recent patients who underwent ESD, therefore, hemostasis is normally achieved for visible vessels in the wound, particularly in rectal lesions.…”