Hemorrhage-prevention value of second-look endoscopy after endoscopic submucosal dissection for early gastric cancer: a meta-analysis / 中华胃肠外科杂志

Objective@#To use the meta-analysis in evaluating the hemorrhage-prevention value of second-look endoscopy after endoscopic submucosal dissection (ESD) for early gastric cancer.@*Methods@#A literature search was conducted to identify all relevant studies comparing second-look endoscopy and non-second-look endoscopy after gastric ESD. The Medline/PubMed, Ovid, Elsevier ScienceDirect, EBSCO, CNKI and VIP databases were searched systematically. Literature inclusion criteria: (1) all the patients were diagnosed as early gastric cancer receiving ESD; (2) end point of the study included postoperative bleeding rate of ESD. Exclusion criteria: (1) papers of repeated research, review, comment, guideline, etc; (2) non-control study. Meta-analysis method was used to calculate a pooled odds ratio (OR) for developing post-ESD bleeding.@*Results@#The meta-analysis showed that post-ESD bleeding was observed in 40 of 1287 patients (3.1%) without second-look endoscopy and in 40 of 968 patients (4.1%) with second- look endoscopy (OR=1.25, 95% CI: 0.79-1.98), with no significant difference between these two groups. Subgroup analysis on research method still indicated no significant difference of post-ESD bleeding between RCT group (OR=1.45,95%CI: 0.79-2.65) and non-RCT group (OR=1.02, 95%CI: 0.50-2.08) (all P>0.05).@*Conclusion@#Based on meta analysis, second-look endoscopy can not reduce the rate of postoperative bleeding of ESD. Therefore, routine second-look endoscopy after gastric ESD may not be necessary to prevent delayed postoperative bleeding of ESD.

Clinical effect of second-look endoscopy in patients with early gastric cancer after ESD / 中国内镜杂志

Objective To evaluate whether second-look endoscopy could prevent endoscopic submucosal dissection complicated with delayed bleeding and to clarify what kind of lesions that need second-look endoscopy. Methods 98 patients with early gastric cancer by histological diagnosis from Oct. 2014 to Sep. 2016 were included in this study. Mucosal damage related bleeding within 24 h after ESD was considered delayed bleeding. Clinical data of patients, lesions, surgical factors, and the incidences of bleeding before and after the second endoscopy examination were retrospectively studied. Results The en bloc resection rate of 98 patients was 100.0%, and all incisal margins were negative. No gastrointestinal perforation, death or severe complications occurred. 5.1%of the patients (5/98) occurred delayed bleeding after ESD and had been successfully stopped in a second-look endoscopy, and none received operations. No delayed bleeding occurred in follow-ups of patients with negative delayed bleeding. 40.0 % of the patients (2/5) with delayed bleeding received blood transfusion. The median time of second-look endoscopy after ESD was the second day after operation (1 ~ 3 d). The median bleeding time of 5 patients with delayed bleeding after ESD was the first day after operation (1 ~ 10 d). The median duration of surgery was 75 min (60~150 min), and the prediction success rate was 94.9 %. The results of univariate analysis showed that age [(69.6 ± 7.9) vs (60.9 ± 10.1) years old, P = 0.003] and operation time [(90.0 ± 41.0) vs (66.0 ± 42.0) min, P = 0.000] were both the risk factors in delayed bleeding and non-bleeding group. Binary Logistic regression analysis showed that operation time (OR

Follow-up value of endoscopy for delayed postoperative bleeding after endoscopic submucosal dissec-tion / 中华消化内镜杂志

Objective To assess whether a follow-up endoscopy after endoscopic submucosal dissec-tion(ESD)for gastric lesions is effective for prevention of delayed bleeding. Methods Papers published in Medline,Embase,Cochrane library,Elsevier,Wanfang,VIP and CNKI were searched for the studies eval-uating the efficacy of follow-up endoscopy for reducing delayed postoperative bleeding after ESD for gastric le-sions. Statistic analyses were performed using RevMan 5. 1 software. Results A total of 10 studies including 4 randomized control trials and 6 cohort studies were enrolled. Analysis of these studies showed that the inci-dence of delayed bleeding was not significantly different between the patients receiving a follow-up endoscopy and those not(OR= 1. 38,95% CI:0. 89-2. 13,P= 0. 15). Also,there was no difference in the incidence of delayed bleeding between the prophylactic hemostasis and nonprophylactic hemostasis groups( OR = 1. 45, 95% CI:0. 65-3. 22,P= 0. 36). Conclusion A follow-up endoscopy after gastric ESD may contribute little to the prevention of delayed bleeding,but may be useful for the high-risk patients,which can control the bleeding rate at a low level.

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

BACKGROUND/AIMS: This stuy evaluated the role of a second-look endoscopy after gastric endoscopic submucosal dissection in patients without signs of bleeding. METHODS: Between 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. RESULTS: The 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). CONCLUSIONS: A routine second-look endoscopy after gastric endoscopic submucosal dissection is not necessary for all patients.

Is a Second-Look Endoscopy Necessary after Endoscopic Submucosal Dissection for Gastric Neoplasm?

BACKGROUND/AIMS: Second-look endoscopy is performed to check for the possibility of post-endoscopic submucosal dissection (ESD) bleeding and to perform prophylactic hemostasis in most hospitals; however, there is little evidence about the efficacy of second-look endoscopy. We investigated whether second-look endoscopy after ESD is useful in the prevention of post-ESD bleeding. METHODS: A total of 550 lesions with gastric epithelial neoplasms in 502 patients (372 men and 130 women) were treated with ESD between August 18, 2009 and August 18, 2010. After the exclusion of three lesions of post-ESD bleeding within 24 hours, 547 lesions (335 early gastric cancers and 212 gastric adenomas) were included for the final analysis. RESULTS: The occurrence rate of delayed post-ESD bleeding was not significantly different between the second-look group and the no second-look group (1% vs 2.5%, p>0.05). The only predictor of delayed bleeding was tumor size, regardless of second-look endoscopy after ESD (22.8+/-9.87 vs 15.1+/-10.47, p<0.05). There was no difference between the prophylactic hemostasis and nonprophylactic hemostasis groups, including the occurrence rate of delayed bleeding. In the second-look group with prophylactic hemostasis, the hospital stay was more prolonged than in the second-look group without prophylactic hemostasis, but there was no significant difference (p=0.08). CONCLUSIONS: Second-look endoscopy to prevent delayed bleeding after ESD provides no significant medical benefits.

The Effect of Second Look Endoscopy in Patients with Peptic Ulcer Bleeding / 대한소화기내시경학회지

BACKGROUND/AIMS: Performing second look endoscopy has been suggested in order to reduce recurrent bleeding. We assessed whether second look endoscopy reduces the risks of recurrent bleeding and the mortality rate for patients suffering with peptic ulcer bleeding. METHODS: From February 2003 to June 2004, we have performed a prospective, randomized, controlled study of 141 patients with bleeding peptic ulcers, and these patients had been admitted to Kyungpook National University Hospital. Seventy patients in the study group were randomized to receive scheduled second look endoscopy. Seventy one patients in the control group were observed closely. RESULTS: Seventeen of the admitted 141 patients were found to have rebleeding after initial therapeutic endoscopy. The overall rebleeding rate was 12.1%. Although the duration of the hospital stay was significantly lower for the study group than for the control group (p<0.05), the rebleeding rate was similar for both groups (p<0.05). The two groups were similar in respect to the mortality during the period of hospitalization, the volume of hypertonic saline epinephrine that was injected and the number of hemoclips that were used. CONCLUSIONS: From these results, we can conclude that scheduled second look endoscopy with retreatment did not reduce the risk of recurrent bleeding for patients with peptic ulcer bleeding. Therefore, scheduled second look endoscopy should be selectively performed for the patients who are at a high risk for peptic ulcer bleeding.

Is Routine Second-Look Endoscopy Necessary for All Bleeding Peptic Ulcers? / 대한소화기내시경학회지

BACKGROUND/AIMS: Second-look endoscopy is generally performed to prevent rebleeding in patients with bleeding peptic ulcers. However, considering recent technologic advances of endoscopic hemostasis and decreasing rate of rebleeding, a small benefit with second-look endoscopy is suggested. Prospective study was carried out to evaluate the efficacy of second-look endoscopic examinations. METHODS AND RESULTS: One hundred thirty six patients with bleeding from peptic ulcer were included. Emergency endoscopic treatments consisting of the injection of hypertonic saline-epinephrine (HSE), band ligation and/or clipping were performed in patients with Forrest class I-IIb. They were scheduled to receive second-look endoscopy in 48 hours after initial endoscopy. Nine patients (6.6%) received endoscopic retreatment during second-look endoscopy and emergency endoscopic retreatment was required before scheduled endoscopy in six patients (4.4%) because of the evidence of rebleeding. Factors influencing retreatment were Forrest classification of initial endoscopy and methods of hemostasis. None of the patients with Forrest class IIb-III and the patients receiving endoscopic band ligation or clipping on initial endoscopy required retreatment during follow-up endoscopy. CONCLUSION: Routine second-look endoscopy may not be recommended after initial successful endoscopic treatment of peptic ulcer bleeding, especially in case of Forrest class IIb, IIc or III and in the patients treated with band ligation or clipping.