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.

Abstract

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.).

• Authors: Ho Yoel Ryu, Jae Woo Kim, Hyun-Soo Kim, Hong Jun Park, Hyo Keun Jeon, So Yeon Park, Bo Ra Kim, Cui Cui Lang, Sung Ho Won
• Journal: Gastrointestinal endoscopy (Gastrointest Endosc) Vol. 78 Issue 2 Pg. 285-94 (Aug 2013) ISSN: 1097-6779 [Electronic] United States
• PMID: 23531425 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2013 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

Topics

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