Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea.
Gut Liver. 2012 Jul;6(3):316-20. doi: 10.5009/gnl.2012.6.3.316. Epub 2012 May 2.
BACKGROUND/AIMS: One major complication of endoscopic submucosal dissection (ESD) is delayed bleeding. Most hospitals routinely perform second-look endoscopy to reduce the chances of delayed bleeding without solid evidence supporting the practice. The aim of this study was to evaluate whether second-look endoscopy prevents delayed bleeding and to verify the clinicopathological features of delayed bleeding to determine how to identify lesions that may require second-look endoscopy.
We investigated 440 lesions in 397 patients who underwent ESD for gastric neoplasm from January 2008 to June 2010. Two-thirds of the enrolled cases were adenomas, and 290 lesions were located in the lower portion of the stomach. Clinically evident bleeding from mucosal defects 24 hours after ESD was considered as delayed bleeding. We reviewed the data, including the characteristics of patients, lesions, and procedures. Furthermore, the rate of delayed bleeding before and after second-look endoscopy, performed within three days of ESD, was investigated to determine the utility of second-look endoscopy.
Delayed bleeding was evident in 9 of 440 lesions (2.0%), all of which underwent endoscopic hemostasis. The only significant factor predicting delayed bleeding was resected specimen over 40 mm in size (p=0.003). Delayed bleeding occurred in 8 of 9 cases (89%) before the second-look endoscopy, which was performed within 72 hours after ESD.
In this study, second-look endoscopy may be useful for preventing post-ESD bleeding, especially when resected specimens are over 40 mm in size.
背景/目的：内镜黏膜下剥离术（ESD）的主要并发症之一是延迟性出血。大多数医院常规进行再次内镜检查，以降低延迟性出血的机会，但没有确凿的证据支持这种做法。本研究旨在评估再次内镜检查是否可以预防延迟性出血，并验证延迟性出血的临床病理特征，以确定如何识别可能需要再次内镜检查的病变。
我们调查了 2008 年 1 月至 2010 年 6 月期间因胃肿瘤而行 ESD 的 397 例患者中的 440 个病灶。三分之二的病例为腺瘤，290 个病灶位于胃下部。ESD 后 24 小时出现黏膜缺损的临床明显出血被认为是延迟性出血。我们回顾了患者、病变和手术的特征等数据。此外，还研究了 ESD 后 3 天内进行的第二次内镜检查（即再次内镜检查）前后延迟性出血的发生率，以确定再次内镜检查的效用。
440 个病灶中有 9 个（2.0%）出现延迟性出血，所有病灶均进行了内镜止血。唯一预测延迟性出血的显著因素是切除标本的大小超过 40mm（p=0.003）。9 例中有 8 例（89%）在 ESD 后 72 小时内进行的第二次内镜检查前出现延迟性出血。
在本研究中，再次内镜检查可能有助于预防 ESD 后出血，尤其是在切除标本大于 40mm 时。
