Jung Ji Hye, Kim Beom Jin, Choi Chang Hwan, Kim Jae G
Ji Hye Jung, Beom Jin Kim, Chang Hwan Choi, Jae G Kim, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul 156-755, South Korea.
World J Gastroenterol. 2015 Dec 28;21(48):13518-23. doi: 10.3748/wjg.v21.i48.13518.
The clinical value of second-look endoscopy (SLE) after endoscopic submucosal dissection (ESD) has been doubted continuously. The aim of this study was to assess the effectiveness of SLE based on the risk of delayed bleeding after ESD.
A total of 310 lesions of gastric epithelial neoplasms treated by ESD were reviewed. The lesions were divided into two groups based on the risk of post-procedural bleeding estimated by Forrest classification. The high risk of rebleeding group (Forrest Ia, Ib and IIa) required endoscopic treatment, while the low risk of rebleeding group (Forrest IIb, IIc and III) did not. Delayed bleeding after ESD was investigated.
Sixty-six lesions were included in the high risk of rebleeding group and 244 lesions in the low risk of rebleeding group. There were no significant differences in delayed bleeding between the high risk group (1/66) and the low risk group (1/244) (P = 0.38). The high risk of rebleeding group tended to be located more often in the mid-third and had higher appearance of flat or depressed shape than the low risk group (P = 0.004 and P = 0.006, respectively).
SLE with pre-emptive prophylactic endoscopic treatment is still effective in preventing delayed bleeding after ESD.
内镜黏膜下剥离术（ESD）后二次内镜检查（SLE）的临床价值一直受到质疑。本研究旨在基于ESD后延迟出血风险评估SLE的有效性。
回顾性分析310例接受ESD治疗的胃上皮肿瘤病变。根据Forrest分类法估计的术后出血风险将病变分为两组。再出血高风险组（Forrest Ia、Ib和IIa）需要内镜治疗，而再出血低风险组（Forrest IIb、IIc和III）则不需要。对ESD后的延迟出血情况进行了调查。
再出血高风险组纳入66个病变，再出血低风险组纳入244个病变。高风险组（1/66）和低风险组（1/244）的延迟出血情况无显著差异（P = 0.38）。再出血高风险组比低风险组更常位于中三分之一部位，且扁平或凹陷形态的出现率更高（分别为P = 0.004和P = 0.006）。
先行预防性内镜治疗的SLE在预防ESD后延迟出血方面仍然有效。
