A Multicenter Survey of the Management After Gastric Endoscopic Submucosal Dissection Related to Postoperative Bleeding
- 454 Downloads
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.
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.
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.
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.
KeywordsEndoscopic submucosal dissection Gastric epithelial neoplasms Postoperative bleeding Second-look endoscopy
Conflict of interest
- 2.Yahagi N, Fujishiro M, Kakushima N, et al. Merits and demerits of endoscopic submucosal dissection using a flex knife (in Japanese with English abstract). Stomach Intestine. 2004;39:39–43.Google Scholar
- 9.Uedo N, Takeuchi Y, Yamada T, et al. Effect of a proton pump inhibitor or an H2-receptor antagonist on prevention of bleeding from ulcer after endoscopic submucosal dissection of early gastric cancer: a prospective randomized controlled trial. Am J Gastroenterol. 2007;102:1610–1616.PubMedCrossRefGoogle Scholar
- 17.Ozawa T, Yoshikawa N, Tomita T, Akita Y, Mitamura K. The influence of feeding on gastric acid suppression in Helicobacter pylori-positive patients treated with a proton pump inhibitor or an H2-receptor antagonist after bleeding from a gastric ulcer. J Gastroenterol. 2003;38:844–848.PubMedCrossRefGoogle Scholar