Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 28, 2015; 21(48): 13518-13523
Published online Dec 28, 2015. doi: 10.3748/wjg.v21.i48.13518
Second-look endoscopy with prophylactic hemostasis is still effective after endoscopic submucosal dissection for gastric neoplasm
Ji Hye Jung, Beom Jin Kim, Chang Hwan Choi, Jae G Kim
Ji 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
Author contributions: Jung JH analysed the data and wrote the paper; Kim BJ designed the research; Choi CH and Kim JG collected the data.
Institutional review board statement: This study was reviewed and approved by the institutional review board of Chung-Ang University College of Medicine, No. C2014088(1284).
Informed consent statement: Informed consent was waived by the institutional review board statement because the study used anonymous clinical data.
Conflict-of-interest statement: No potential conflict of interest relevant to this article was reported.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Beom Jin Kim, MD, PhD, Department of Internal Medicine, Chung-Ang University College of Medicine, 224-1 Heukseok-dong, Dongjak-gu, Seoul 156-755, South Korea. kimbj@cau.ac.kr
Telephone: +82-2-62991355 Fax: +82-2-62991137
Received: September 30, 2015
Peer-review started: October 1, 2015
First decision: November 5, 2015
Revised: November 19, 2015
Accepted: December 12, 2015
Article in press: December 14, 2015
Published online: December 28, 2015
Processing time: 84 Days and 15.7 Hours
Abstract

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.

Keywords: Second-look endoscopy; Forrest classification; Endoscopic submucosal dissection; Delayed bleeding

Core tip: This is a retrospective study to assess the effectiveness of second-look endoscopy (SLE) based on the risk of delayed bleeding after endoscopic submucosal dissection (ESD). 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. As a result, there were no significant differences in delayed bleeding between the high risk group and the low risk group. However, 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. In conclusion, SLE with pre-emptive prophylactic endoscopic treatment is still effective in preventing delayed bleeding after ESD.