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World J Gastrointest Endosc. Feb 10, 2016; 8(3): 173-179
Published online Feb 10, 2016. doi: 10.4253/wjge.v8.i3.173
Second-look endoscopy and factors associated with delayed bleeding after endoscopic submucosal dissection
Su-Jin Kim, Cheol-Woong Choi, Dae-Hwan Kang, Hyung-Wook Kim, Su-Bum Park
Su-Jin Kim, Cheol-Woong Choi, Dae-Hwan Kang, Hyung-Wook Kim, Su-Bum Park, Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 626-770, South Korea
Author contributions: Kim SJ wrote the manuscript; Choi CW organized the manuscript; Kang DH, Kim HW and Park SB contributed to the design, organization, and draft of the manuscript; all authors read and approved the final manuscript.
Conflict-of-interest statement: The authors declare no conflict of interests.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Cheol-Woong Choi, MD, Department of Internal Medicine, 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, Yangsan 626-770, South Korea. luckyace@hanmail.net
Telephone: +82-55-3601535 Fax: +82-55-3601536
Received: April 20, 2015
Peer-review started: April 21, 2015
First decision: September 8, 2015
Revised: October 1, 2015
Accepted: December 4, 2015
Article in press: December 8, 2015
Published online: February 10, 2016
Abstract

Endoscopic submucosal dissection (ESD) is a widely used procedure as curative treatment for superficial gastric neoplasms, including early gastric cancer without lymph node metastasis. However, ESD requires advanced endoscopic skill and there is a major concern regarding complications from bleeding. So far, extensive efforts have been made to develop strategies to reduce post-ESD bleeding. Use of proton pump inhibitors and coagulating exposed vessels on the ulcer floor after ESD are strategies known to reduce the risk of delayed bleeding. Second-look endoscopy (SLE) is also carried out to reduce delayed bleeding following ESD in many institutions. However, the incidence of bleeding still remains around 5%, and further measures are needed to reduce delayed bleeding after gastric ESD. Recently, three randomized studies indicated that routine SLE was unnecessary. Although routine SLE may not be recommended for all patients after gastric ESD, SLE might be an important tool for the prevention of the delayed bleeding in selected high-risk patients. Thus, the identification of the risk factors, such as large size of resected specimen and treatment with multiple antiplatelet medications, may help to further guide clinicians in deciding whether to perform SLE. Studies carried out on larger cohorts are necessary to clarify the efficacy of SLE after ESD in the prevention of post-ESD bleeding in potentially high-risk patients.

Keywords: Endoscopic submucosal dissection, Second-look endoscopy, Early gastric cancer

Core tip: Second-look endoscopy (SLE) for selected patients might be an important tool for the prevention of delayed bleeding following endoscopic submucosal dissection (ESD). Risk factors for bleeding after ESD include large size of resected specimen and use of multiple antiplatelet agents. In addition, submucosal fibrosis and nausea might be risk factors associated with high-risk ulcer stigmata. Such risk factors require further evaluation as to whether SLE is indicated.