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Clinical outcomes of second-look endoscopy after gastric endoscopic submucosal dissection: predictive factors with high risks of bleeding

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Abstract

Background

A second-look endoscopy is routinely performed after endoscopic submucosal dissection (ESD) in many institutions, although the need is questionable. Additional hemostatic procedures might be necessary for the post-ESD ulcer with a high risk of bleeding. We investigated the predictive factors for post-ESD ulcers with a high risk of bleeding.

Methods

Second-look endoscopy was performed on the day following ESD. The post-ESD ulcers were categorized into two risk groups according to the Forrest classification: high-risk ulcer stigma (type I and IIa) and low-risk ulcer stigma. We analyzed the risk factors associated with high-risk ulcer stigma and late delayed bleeding.

Results

During the study period, 616 ESD procedures were performed. Second-look endoscopy revealed that the incidence of high-risk ulcer stigma post-ESD was 15.1 %. Early and late delayed bleeding rates were 3.7 and 1.9 %, respectively. Multivariate analysis revealed that submucosal fibrosis and nausea were significantly related to high-risk ulcer stigma after ESD. Multivariate analysis revealed that surface erosion, location of the lesion, and high-risk ulcer stigma identified by second-look endoscopy were significantly associated with late delayed bleeding.

Conclusions

The effective use of selective second-look endoscopy will help limit unnecessary procedures. Submucosal fibrosis and nausea were risk factors associated with high-risk ulcer stigma after ESD.

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Disclosures

Cheol Woong Choi, Hyung Wook Kim, Dae Hwan Kang, Yong Mi Hong, Su Jin Kim, Su Bum Park, Mong Cho, Dong Jun Kim, and Joung Boom Hong have no conflicts of interest or financial ties to disclose. The authors alone are responsible for the content and writing of the paper.

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Authors and Affiliations

  1. Department of Internal Medicine, Medical Research Institute, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Beomeo-ri, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, 626-770, Korea

    Cheol Woong Choi, Hyung Wook Kim, Dae Hwan Kang, Yong Mi Hong, Su Jin Kim, Su Bum Park, Mong Cho, Dong Jun Kim & Joung Boom Hong

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  1. Cheol Woong Choi
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  2. Hyung Wook Kim
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  3. Dae Hwan Kang
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  5. Su Jin Kim
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  6. Su Bum Park
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  7. Mong Cho
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  8. Dong Jun Kim
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  9. Joung Boom Hong
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Correspondence to Cheol Woong Choi.

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Choi, C.W., Kim, H.W., Kang, D.H. et al. Clinical outcomes of second-look endoscopy after gastric endoscopic submucosal dissection: predictive factors with high risks of bleeding. Surg Endosc 28, 2213–2220 (2014). https://doi.org/10.1007/s00464-014-3457-2

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  • DOI: https://doi.org/10.1007/s00464-014-3457-2

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