Digestive Diseases and Sciences

, Volume 57, Issue 2, pp 435–439

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

Authors

    • Department of Gastroenterology, Graduate School of MedicineThe University of Tokyo
  • Mitsuhiro Fujishiro
    • Department of Endoscopy and Endoscopic Surgery, Graduate School of MedicineThe University of Tokyo
  • Ichiro Oda
    • Endoscopy DivisionNational Cancer Center Hospital
  • Naomi Kakushima
    • Endoscopy DivisionShizuoka Cancer Center
  • Yorimasa Yamamoto
    • Department of GastroenterologyCancer Institute Hospital
  • Yosuke Tsuji
    • Department of GastroenterologyNTT Medical Center Tokyo
  • Ken Ohata
    • Department of GastroenterologyNTT Medical Center Tokyo
  • Takashi Fujiwara
    • Department of GastroenterologyTokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital
  • Junko Fujiwara
    • Department of GastroenterologyTokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital
  • Naoki Ishii
    • Department of GastroenterologySt Luke’s International Hospital
  • Chizu Yokoi
    • Department of GastroenterologyNational Center for Global Health and Medicine
  • Shinichi Miyamoto
    • Department of GastroenterologyThe University of Kyoto
  • Toshiyuki Itoh
    • Department of GastroenterologyThe University of Kyoto
  • Shinji Morishita
    • Department of GastroenterologyTokyo Koseinenkin Hospital
  • Takuji Gotoda
    • Department of GastroenterologyNational Center for Global Health and Medicine
  • Kazuhiko Koike
    • Department of Gastroenterology, Graduate School of MedicineThe University of Tokyo
Original Article

DOI: 10.1007/s10620-011-1886-5

Cite this article as:
Goto, O., Fujishiro, M., Oda, I. et al. Dig Dis Sci (2012) 57: 435. doi:10.1007/s10620-011-1886-5

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 dissectionGastric epithelial neoplasmsPostoperative bleedingSecond-look endoscopy

Copyright information

© Springer Science+Business Media, LLC 2011