Published online Nov 7, 2020. doi: 10.3748/wjg.v26.i41.6475
Peer-review started: June 26, 2020
First decision: September 12, 2020
Revised: September 22, 2020
Accepted: October 20, 2020
Article in press: October 20, 2020
Published online: November 7, 2020
Endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) is minimally invasive and the gold standard for treatment for endoscopic resection. However, the problem of postoperative delayed bleeding (PDB) as a major adverse event remains.
The PDB rate under antithrombotic therapy (ATT) is higher than non-ATT and the bleeding period tends to be a late phase. Despite several attempts against PDB have been reported, there are no effective preventive methods yet.
We attempted to verify the efficacy of third-look endoscopy (TLE) against PDB in patients under ATT.
This is a prospective study in a single center. We enrolled patients with EGC receiving ATT, and TLE was added to conventional ESD, including second-look endoscopy. Additionally, we compared the PDB rate with that of a historical control group subjected to conventional ESD under ATT, using propensity score matching.
The PDB rate of patients adding TLE was lower than the threshold which we set, and it was significantly lower, especially late-onset PDB (L-PDB). Regarding the comparison with the historical control group, the L-PDB rate in the TLE group was lower.
TLE is a simple method that reduces the overall PDB, especially L-PDB, in patients under ATT and is widely acceptable by endoscopists.
This study is not a randomized controlled trial (RCT); therefore, we consider it necessary to investigate RCT against a larger patient sample.