Second-look endoscopy and factors associated with delayedbleeding after endoscopic submucosal dissection

• 作者: Cheol-Woong Choi Dae-Hwan Kang Hyung-Wook Kim Su-Bum Park Su-Jin Kim
• 来源期刊: 世界胃肠内镜杂志：英文版（电子版）
• 学科: 医学
• 关键词: ENDOSCOPIC SUBMUCOSAL DISSECTION Secondlookendoscopy Early GASTRIC cancer
• 年，卷（期）: 2016,（3）
• 页码范围: 173-179
• 页数: 7页
• 分类号: R

摘要

Endoscopic submucosal dissection （ESD） is a widelyused procedure as curative treatment for superficialgastric neoplasms, including early gastric cancer withoutlymph node metastasis. However, ESD requiresadvanced endoscopic skill and there is a major concernregarding complications from bleeding. So far, extensiveefforts have been made to develop strategies to reducepost-ESD bleeding. Use of proton pump inhibitors andcoagulating exposed vessels on the ulcer ？oor afterESD are strategies known to reduce the risk of delayedbleeding. Second-look endoscopy （SLE） is also carriedout to reduce delayed bleeding following ESD in manyinstitutions. However, the incidence of bleeding stillremains around 5%, and further measures are neededto reduce delayed bleeding after gastric ESD. Recently,three randomized studies indicated that routine SLEwas unnecessary. Although routine SLE may not berecommended for all patients after gastric ESD, SLEmight be an important tool for the prevention of thedelayed bleeding in selected high-risk patients. Thus,the identification of the risk factors, such as large sizeof resected specimen and treatment with multipleantiplatelet medications, may help to further guideclinicians in deciding whether to perform SLE. Studiescarried out on larger cohorts are necessary to clarify theefficacy of SLE after ESD in the prevention of post-ESDbleeding in potentially high-risk patients.