Second-look endoscopy is not associated with better clinical outcomes after gastric endoscopic submucosal dissection: a prospective, randomized, clinical trial analyzed on an as-treated basis

Gastrointest Endosc. 2013 Aug;78(2):285-94. doi: 10.1016/j.gie.2013.02.008. Epub 2013 Mar 24.


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.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adenocarcinoma / surgery*
  • Aged
  • Dissection / methods
  • Female
  • Gastric Mucosa / surgery*
  • Gastroscopy / methods*
  • Humans
  • Male
  • Middle Aged
  • Postoperative Hemorrhage / diagnosis*
  • Postoperative Hemorrhage / prevention & control
  • Second-Look Surgery / methods*
  • Stomach Neoplasms / surgery*
  • Tertiary Care Centers
  • Treatment Outcome