Background: The efficacy of routine second-look endoscopy (SLE) to detect or prevent bleeding after gastric endoscopic submucosal dissection (ESD) has not yet been validated.
Objective: The aim of this study was to determine whether SLE affects clinical outcomes including bleeding and morbidity after gastric ESD.
Design: A prospective, randomized, controlled study with consecutive data analyzed on an as-treated basis.
Setting: A single, tertiary-care referral center.
Patients: A total of 182 patients.
Intervention: Gastric ESD and SLE.
Main outcome measurements: Incidence of and risk factors related to bleeding after ESD and outcomes by univariate or multivariate analysis.
Results: Among 182 patients enrolled, 74 and 81 patients were assigned to the SLE and no-SLE groups, respectively. Two groups were observed closely for 4 weeks. Bleeding occurred after ESD in 21 patients (13.5%). Hemoglobin loss (≥2.0 g/dL) was observed in 20 patients, and melena developed in 1 patient after ESD. However, only 1 patient needed a transfusion. Twelve patients (16.2%) in the SLE group and 9 in the no-SLE group (11.1%) experienced bleeding after ESD. The frequency of bleeding after ESD was not significantly different between the 2 groups (P = .66). There were no risk factors related to bleeding after ESD.
Limitations: Single-center analysis.
Conclusion: SLE is not routinely necessary because it does not affect clinical outcomes, including bleeding and morbidity after ESD. (
Clinical trial registration number: KCT0000146.).
Keywords: APC; ESD; PT; SLE; aPTT; activated partial thromboplastin time; argon plasma coagulation; endoscopic submucosal dissection; prothrombin time; second-look endoscopy.
Copyright © 2013 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.