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

  • Osamu Goto
  • Mitsuhiro Fujishiro
  • Ichiro Oda
  • Naomi Kakushima
  • Yorimasa Yamamoto
  • Yosuke Tsuji
  • Ken Ohata
  • Takashi Fujiwara
  • Junko Fujiwara
  • Naoki Ishii
  • Chizu Yokoi
  • Shinichi Miyamoto
  • Toshiyuki Itoh
  • Shinji Morishita
  • Takuji Gotoda
  • Kazuhiko Koike
Original Article

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 

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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Osamu Goto
    • 1
  • Mitsuhiro Fujishiro
    • 2
  • Ichiro Oda
    • 3
  • Naomi Kakushima
    • 4
  • Yorimasa Yamamoto
    • 5
  • Yosuke Tsuji
    • 6
  • Ken Ohata
    • 6
  • Takashi Fujiwara
    • 7
  • Junko Fujiwara
    • 7
  • Naoki Ishii
    • 8
  • Chizu Yokoi
    • 9
  • Shinichi Miyamoto
    • 10
  • Toshiyuki Itoh
    • 10
  • Shinji Morishita
    • 11
  • Takuji Gotoda
    • 9
  • Kazuhiko Koike
    • 1
  1. 1.Department of Gastroenterology, Graduate School of MedicineThe University of TokyoTokyoJapan
  2. 2.Department of Endoscopy and Endoscopic Surgery, Graduate School of MedicineThe University of TokyoTokyoJapan
  3. 3.Endoscopy DivisionNational Cancer Center HospitalTokyoJapan
  4. 4.Endoscopy DivisionShizuoka Cancer CenterShizuokaJapan
  5. 5.Department of GastroenterologyCancer Institute HospitalTokyoJapan
  6. 6.Department of GastroenterologyNTT Medical Center TokyoTokyoJapan
  7. 7.Department of GastroenterologyTokyo Metropolitan Cancer and Infectious Diseases Center Komagome HospitalTokyoJapan
  8. 8.Department of GastroenterologySt Luke’s International HospitalTokyoJapan
  9. 9.Department of GastroenterologyNational Center for Global Health and MedicineTokyoJapan
  10. 10.Department of GastroenterologyThe University of KyotoKyotoJapan
  11. 11.Department of GastroenterologyTokyo Koseinenkin HospitalTokyoJapan

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