A second-look endoscopy after endoscopic submucosal dissection for gastric epithelial neoplasm may be unnecessary: a retrospective analysis of postendoscopic submucosal dissection bleeding

Gastrointest Endosc. 2010 Feb;71(2):241-8. doi: 10.1016/j.gie.2009.08.030. Epub 2009 Nov 17.


Background: Endoscopic submucosal dissection (ESD) is one of the curative endoluminal surgical procedures for gastric epithelial neoplasms. There has been little research on bleeding after gastric ESD.

Objective: To investigate cases of post-ESD bleeding and to verify whether a second-look endoscopy after ESD is effective in the prevention of delayed bleeding.

Design: A retrospective study with consecutive data.

Setting: A single tertiary referral center.

Subjects: A total of 454 gastric epithelial neoplasms (386 early gastric cancers and 68 gastric adenomas).

Interventions: ESD and second-look endoscopy.

Main outcome measurements: Predictors on post-ESD bleeding by univariate analysis, incidence of post-ESD bleedings, and the timing of those before and after second-look endoscopy.

Results: Post-ESD bleeding occurred in 26 (5.7%) lesions. Gross type (flat or depressed type) was the only factor influencing post-ESD bleeding. All cases of post-ESD bleeding occurred within 14 days after ESD (median 2; range 0-14), and bleeding tended to occur from the lower and upper stomach earlier and later, respectively. In 19 lesions with delayed bleeding more than 24 hours after ESD, the maximum delayed bleeding rates before and after the second-look endoscopy were 2.8% and 2.5%, respectively.

Limitations: A retrospective, single-center analysis.

Conclusions: A second-look endoscopy after gastric ESD may contribute little to the prevention of delayed bleeding.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Analysis of Variance
  • Cohort Studies
  • Dissection
  • Female
  • Follow-Up Studies
  • Gastric Mucosa / pathology
  • Gastric Mucosa / surgery
  • Gastrointestinal Hemorrhage / etiology
  • Gastrointestinal Hemorrhage / prevention & control*
  • Gastroscopy / adverse effects*
  • Gastroscopy / methods
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Minimally Invasive Surgical Procedures / adverse effects
  • Minimally Invasive Surgical Procedures / methods
  • Neoplasm Staging
  • Neoplasms, Glandular and Epithelial / pathology
  • Neoplasms, Glandular and Epithelial / surgery*
  • Postoperative Hemorrhage / etiology
  • Postoperative Hemorrhage / prevention & control*
  • Probability
  • Retrospective Studies
  • Risk Assessment
  • Second-Look Surgery
  • Stomach Neoplasms / pathology
  • Stomach Neoplasms / surgery*
  • Unnecessary Procedures*