Kim Jong Sun, Chung Min Woo, Chung Cho Yun, Park Hyung Chul, Ryang Dae Yeul, Myung Dae Seong, Cho Sung Bum, Lee Wan Sik, Joo Young Eun
Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
Gut Liver. 2014 Sep;8(5):480-6. doi: 10.5009/gnl13226. Epub 2014 Feb 24.
BACKGROUND/AIMS: Many authors recommend performing a second-look endoscopy (SLE) to reduce the frequency of delayed bleeding after endoscopic submucosal dissection (ESD) for gastric neoplasms, but these recommendations have been made despite a lack of reliable evidence supporting the effectiveness of SLE.
From January 2012 to May 2013, we investigated 441 gastric neoplasms treated by ESD to assess the risk factors for delayed bleeding. Delayed bleeding occurred in four of these lesions within 1 postoperation day. Therefore, we enrolled the patients with the remaining 437 lesions to determine the utility of SLE performed on the morning of postoperative day 2. All lesions were randomly assigned to SLE (220 lesions) groups or non-SLE (217 lesions) groups.
Delayed bleeding occurred in 18 lesions (4.1%). A large tumor size (>20 mm) was the only independent risk factor for delayed bleeding (p=0.007). The chance of delayed bleeding was not significantly different between the patients receiving a SLE (eight cases) and those patients not receiving a SLE (six cases, p=0.787). Furthermore, SLE for lesions with a large tumor size did not significantly decrease delayed bleeding (p=0.670).
SLE had little or no influence on the prevention of delayed bleeding, irrespective of the risk factors.
背景/目的：许多作者建议进行二次内镜检查（SLE）以降低胃肿瘤内镜黏膜下剥离术（ESD）后延迟性出血的发生率，但尽管缺乏支持SLE有效性的可靠证据，仍提出了这些建议。
2012年1月至2013年5月，我们对441例接受ESD治疗的胃肿瘤进行了调查，以评估延迟性出血的危险因素。其中4个病变在术后1天内发生延迟性出血。因此，我们将其余437个病变的患者纳入研究，以确定术后第2天上午进行SLE的效用。所有病变随机分为SLE组（220个病变）和非SLE组（217个病变）。
18个病变（4.1%）发生延迟性出血。肿瘤较大（>20mm）是延迟性出血的唯一独立危险因素（p=0.007）。接受SLE的患者（8例）和未接受SLE的患者（6例，p=0.787）延迟性出血的发生率无显著差异。此外，对肿瘤较大的病变进行SLE并不能显著减少延迟性出血（p=0.670）。
无论危险因素如何，SLE对预防延迟性出血几乎没有影响。
