Original Article

Digestive Diseases and Sciences

, Volume 57, Issue 2, pp 435-439

First online:

A Multicenter Survey of the Management After Gastric Endoscopic Submucosal Dissection Related to Postoperative Bleeding

  • Osamu GotoAffiliated withDepartment of Gastroenterology, Graduate School of Medicine, The University of Tokyo Email author 
  • , Mitsuhiro FujishiroAffiliated withDepartment of Endoscopy and Endoscopic Surgery, Graduate School of Medicine, The University of Tokyo
  • , Ichiro OdaAffiliated withEndoscopy Division, National Cancer Center Hospital
  • , Naomi KakushimaAffiliated withEndoscopy Division, Shizuoka Cancer Center
  • , Yorimasa YamamotoAffiliated withDepartment of Gastroenterology, Cancer Institute Hospital
  • , Yosuke TsujiAffiliated withDepartment of Gastroenterology, NTT Medical Center Tokyo
  • , Ken OhataAffiliated withDepartment of Gastroenterology, NTT Medical Center Tokyo
  • , Takashi FujiwaraAffiliated withDepartment of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital
  • , Junko FujiwaraAffiliated withDepartment of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital
    • , Naoki IshiiAffiliated withDepartment of Gastroenterology, St Luke’s International Hospital
    • , Chizu YokoiAffiliated withDepartment of Gastroenterology, National Center for Global Health and Medicine
    • , Shinichi MiyamotoAffiliated withDepartment of Gastroenterology, The University of Kyoto
    • , Toshiyuki ItohAffiliated withDepartment of Gastroenterology, The University of Kyoto
    • , Shinji MorishitaAffiliated withDepartment of Gastroenterology, Tokyo Koseinenkin Hospital
    • , Takuji GotodaAffiliated withDepartment of Gastroenterology, National Center for Global Health and Medicine
    • , Kazuhiko KoikeAffiliated withDepartment of Gastroenterology, Graduate School of Medicine, The University of Tokyo

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Abstract

Background and Aims

Bleeding is a major complication after gastric endoscopic submucosal dissection (ESD). An evidence-based strategy for postoperative care related to delayed bleeding is required. We conducted a multicenter survey to assess the current status of management after gastric ESD.

Methods

A total of 1,814 gastric epithelial neoplasms in 2009 at ten tertiary referral centers were enrolled. The current status of the management after gastric ESD (use of an antisecretory drug, food intake, and second-look endoscopy) at participating hospitals was assessed. Furthermore, the rate of post-ESD bleeding and the differences in each parameter were retrospectively analyzed.

Results

Postoperative bleeding occurred in 100 cases (5.5%), which included 62 cases of bleeding within 24 h after ESD. In all of the hospitals, proton pump inhibitors (PPIs) were used. The median administration period was 56 days (range 14–60 days). Food intake was resumed from postoperative day (POD) 1 in 4 hospitals and from POD 2 in 6 hospitals. Second-look endoscopy was performed for almost all cases, fewer cases, and rarely or none in 6, 2, and 2 hospitals, respectively. The day of second-look endoscopy varied among hospitals. There was no statistical relationship between the postoperative bleeding rate and the differences in these three parameters.

Conclusions

Post-ESD management (duration of PPI use, resumption of food intake, and performance of second-look endoscopy) varied among the medical centers; thus, randomized controlled trials are required for an optimal strategy after gastric ESD.

Keywords

Endoscopic submucosal dissection Gastric epithelial neoplasms Postoperative bleeding Second-look endoscopy