Efficacy of second‑look endoscopy in preventing delayed bleeding after endoscopic submucosal dissection of early gastric cancer

Guo,Zhiguo; Miao,Lin; Chen,Lijuan; Hao,Hongsheng; Xin,Yi

doi:10.3892/etm.2018.6729

Efficacy of second‑look endoscopy in preventing delayed bleeding after endoscopic submucosal dissection of early gastric cancer

Authors:
- Zhiguo Guo
- Lin Miao
- Lijuan Chen
- Hongsheng Hao
- Yi Xin
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Affiliations: Department of Gastroenterology, Suzhou Municipal Hospital, Suzhou, Anhui 234000, P.R. China, Medical Center for Digestive Diseases, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210011, P.R. China, Department of Gastroenterology, Central Hospital of Shandong Energy Zaozhuang Mining Group, Zaozhuang, Shandong 277100, P.R. China, Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
Published online on: September 12, 2018 https://doi.org/10.3892/etm.2018.6729
Pages: 3855-3862
Copyright: © Guo et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

The present study aimed to evaluate whether second‑look endoscopy (SLE) is able to prevent delayed bleeding after endoscopic submucosal dissection (ESD) of gastric carcinoma and to identify which types of lesion require SLE. ESD of gastric cancer at the early stage was performed on 210 patients between October 2014 and September 2016. Mucosal damage‑associated bleeding within 24 h after ESD was considered as delayed bleeding. The association of the characteristics of patients and lesions, as well as surgical factors, with the incidence of bleeding as a measure of outcome was analyzed. A total of 110 patients with melena and/or hematemesis underwent SLE on the second day following gastric ESD. Within the entire cohort (n=210), late delayed bleeding (LDB) was defined as hematemesis or melena occurring following second‑look endoscopy. Early delayed bleeding (EDB) was defined as hematemesis or melena occurring from the end of ESD to second‑look endoscopy, or as active or possible bleeding at the time of the second‑look endoscopy was reported in 17 (8.1%) and 20 patients(9.5%), respectively. The median interval between late delayed bleeding and ESD was one day (range, 1‑10 days). The incidence of late delayed bleeding was significantly decreased in the SLE group compared with that in the non‑SLE group (4.5 vs. 12%, P=0.028). Multivariate analyses revealed that ulcer, flat gross type, lesion diameter (>2 cm), the resected tumor size of >40 mm and Helicobacter pylori infection were independently associated with late delayed bleeding after ESD, while flat gross type, ulcer, the resected tumor size of >40 mm and artificial ulcer diameter >3 cm were independently associated with early delayed bleeding. Thus, the data of the present study indicates that second‑look endoscopy following gastric ESD may be useful in preventing post‑ESD delayed bleeding and should be performed on the second day.

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1	Thrumurthy SG, Chaudry MA, Hochhauser D and Mughal M: The diagnosis and management of gastric cancer. BMJ. 347:f63672013. View Article : Google Scholar : PubMed/NCBI
2	Kohler BA, Ward E, McCarthy BJ, Schymura MJ, Ries LA, Eheman C, Jemal A, Anderson RN, Ajani UA and Edwards BK: Annual report to the nation on the status of cancer, 1975–2007, featuring tumors of the brain and other nervous system. J Natl Cancer Inst. 103:714–736. 2011. View Article : Google Scholar : PubMed/NCBI
3	Yang L: Incidence and mortality of gastric cancer in China. World J Gastroenterol. 12:17–20. 2006. View Article : Google Scholar : PubMed/NCBI
4	Salih BA: Helicobacter pylori infection in developing countries: The burden for how long? Saudi J Gastroenterol. 15:201–207. 2009. View Article : Google Scholar : PubMed/NCBI
5	NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines), . Gastric Cancer. Version 2.2017. National Comprehensive Cancer Network; Fort Washington: 2017
6	Wang S, Zhang Z, Liu M, Li S and Jiang C: Endoscopic resection compared with gastrectomy to treat early gastric cancer: A systematic review and meta-analysis. PLoS One. 10:e01447742015. View Article : Google Scholar : PubMed/NCBI
7	Ono H, Yao K, Fujishiro M, Oda I, Nimura S, Yahagi N, Iishi H, Oka M, Ajioka Y, Ichinose M and Matsui T: Guidelines for endoscopic submucosal dissection and endoscopic mucosal resection for early gastric cancer. Dig Endosc. 28:3–15. 2016. View Article : Google Scholar : PubMed/NCBI
8	Inoue H, Ikeda H, Hosoya T, Yoshida A, Onimaru M, Suzuki M and Kudo SE: Endoscopic mucosal resection, endoscopic submucosal dissection, and beyond: Full-layer resection for gastric cancer with nonexposure technique (CLEAN-NET). Surg Oncol Clin N Am. 21:129–140. 2012. View Article : Google Scholar : PubMed/NCBI
9	Facciorusso A, Antonino M, Di Maso M and Muscatiello N: Endoscopic submucosal dissection vs endoscopic mucosal resection for early gastric cancer: A meta-analysis. World J Gastrointest Endosc. 6:555–563. 2014. View Article : Google Scholar : PubMed/NCBI
10	Park CH, Shin S, Park JC, Shin SK, Lee SK, Lee YC and Lee H: Long-term outcome of early gastric cancer after endoscopic submucosal dissection: Expanded indication is comparable to absolute indication. Dig Liver Dis. 45:651–656. 2013. View Article : Google Scholar : PubMed/NCBI
11	Goto O, Fujishiro M, Kodashima S, Ono S, Niimi K, Hirano K, Yamamichi N and Koike K: A second-look endoscopy after endoscopic submucosal dissection for gastric epithelial neoplasm may be unnecessary: A retrospective analysis of postendoscopic submucosal dissection bleeding. Gastrointest Endosc. 71:241–248. 2010. View Article : Google Scholar : PubMed/NCBI
12	Kataoka Y, Tsuji Y, Sakaguchi Y, Minatsuki C, Asada-Hirayama I, Niimi K, Ono S, Kodashima S, Yamamichi N, Fujishiro M and Koike K: Bleeding after endoscopic submucosal dissection: Risk factors and preventive methods. World J Gastroenterol. 22:5927–5935. 2016. View Article : Google Scholar : PubMed/NCBI
13	Kang KJ, Kim KM, Min BH, Lee JH and Kim JJ: Endoscopic submucosal dissection of early gastric cancer. Gut Liver. 5:418–426. 2011. View Article : Google Scholar : PubMed/NCBI
14	Ono S, Ono M, Nakagawa M, Shimizu Y, Kato M and Sakamoto N: Delayed bleeding and hemorrhage of mucosal defects after gastric endoscopic submucosal dissection on second-look endoscopy. Gastric Cancer. 19:561–567. 2016. View Article : Google Scholar : PubMed/NCBI
15	Akintoye E, Obaitan I, Muthusamy A, Akanbi O, Olusunmade M and Levine D: Endoscopic submucosal dissection of gastric tumors: A systematic review and meta-analysis. World J Gastrointest Endosc. 8:517–532. 2016. View Article : Google Scholar : PubMed/NCBI
16	Kim JS, Chung MW, Chung CY, Park HC, Ryang DY, Myung DS, Cho SB, Lee WS and Joo YE: The need for second-look endoscopy to prevent delayed bleeding after endoscopic submucosal dissection for gastric neoplasms: A prospective randomized trial. Gut Liver. 8:480–486. 2014. View Article : Google Scholar : PubMed/NCBI
17	Mochizuki S, Uedo N, Oda I, Kaneko K, Yamamoto Y, Yamashina T, Suzuki H, Kodashima S, Yano T, Yamamichi N, et al: Scheduled second-look endoscopy is not recommended after endoscopic submucosal dissection for gastric neoplasms (the SAFE trial): A multicentre prospective randomised controlled non-inferiority trial. Gut. 64:397–405. 2015. View Article : Google Scholar : PubMed/NCBI
18	Takahashi F, Yoshitake N, Akima T, Kino H, Nakano M, Tsuchida C, Tsuchida K, Tominaga K, Sasai T, Masuyama H and Hiraishi H: A second-look endoscopy may not reduce the bleeding after endoscopic submucosal dissection for gastric epithelial neoplasm. BMC Gastroenterol. 14:1522014. View Article : Google Scholar : PubMed/NCBI
19	Ryu HY, Kim JW, Kim HS, Park HJ, Jeon HK, Park SY, Kim BR, Lang CC and Won SH: Second-look endoscopy is not associated with better clinical outcomes after gastric endoscopic submucosal dissection: A prospective, randomized, clinical trial analyzed on an as-treated basis. Gastrointestl Endosc. 78:285–294. 2013. View Article : Google Scholar
20	Na S, Ahn JY, Choi KD, Kim MY, Lee JH, Choi KS, Kim DH, Song HJ, Lee GH, Jung HY and Kim JH: Delayed bleeding rate according to the Forrest classification in second-look endoscopy after endoscopic submucosal dissection. Dig Dis Sci. 60:3108–3117. 2015. View Article : Google Scholar : PubMed/NCBI
21	Isomoto H, Shikuwa S, Yamaguchi N, Fukuda E, Ikeda K, Nishiyama H, Ohnita K, Mizuta Y, Shiozawa J and Kohno S: Endoscopic submucosal dissection for early gastric cancer: A large-scale feasibility study. Gut. 58:331–336. 2009. View Article : Google Scholar : PubMed/NCBI
22	Okada K, Yamamoto Y, Kasuga A, Omae M, Kubota M, Hirasawa T, Ishiyama A, Chino A, Tsuchida T, Fujisaki J, et al: Risk factors for delayed bleeding after endoscopic submucosal dissection for gastric neoplasm. Surg Endosc. 25:98–107. 2011. View Article : Google Scholar : PubMed/NCBI
23	Takizawa K, Oda I, Gotoda T, Yokoi C, Matsuda T, Saito Y, Saito D and Ono H: Routine coagulation of visible vessels may prevent delayed bleeding after endoscopic submucosal dissection-an analysis of risk factors. Endoscopy. 40:179–183. 2008. View Article : Google Scholar : PubMed/NCBI
24	Choi CW, Kim HW, Kang DH, Hong YM, Kim SJ, Park SB, Cho M, Kim DJ and Hong JB: Clinical outcomes of second-look endoscopy after gastric endoscopic submucosal dissection: Predictive factors with high risks of bleeding. Surg Endosc. 28:2213–2220. 2014. View Article : Google Scholar : PubMed/NCBI
25	Fujishiro M, Abe N, Endo M, Kawahara Y, Shimoda R, Nagata S, Homma K, Morita Y and Uedo N: Current managements and outcomes of peptic and artificial ulcer bleeding in Japan. Dig Endosc. 22 Suppl 1:S9–S14. 2010. View Article : Google Scholar : PubMed/NCBI
26	Tano S, Horiki N, Omata F, Tanaka K, Hamada Y, Katsurahara M, Ninomiya K, Nishikawa K, Nojiri K, Yamada R, et al: Second and third-look endoscopy for the prevention of post-ESD bleeding. Medicine (Baltimore). 94:e4912015. View Article : Google Scholar : PubMed/NCBI
27	Nakamura M, Nishikawa J, Hamabe K, Nishimura J, Satake M, Goto A, Kiyotoki S, Saito M, Fukagawa Y, Shirai Y, et al: Risk factors for delayed bleeding from endoscopic submucosal dissection of gastric neoplasms. Scand J Gastroenterol. 47:1108–1114. 2012. View Article : Google Scholar : PubMed/NCBI
28	Guo Z, Xin Y, Dai H and Cao J: Second-look endoscopy could be effective in preventing delayed bleeding after gastric endoscopic submucosal dissection. Abstract No: PO-937. In: The 17th Congress of Gastroenterology China (CGC). 2017.