Cheol Woong Choi1, Hyung Wook Kim, Dae Hwan Kang, Yong Mi Hong, Su Jin Kim, Su Bum Park, Mong Cho, Dong Jun Kim, Joung Boom Hong. 1. Department of Internal Medicine, Medical Research Institute, 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, Gyeongsangnam-do, 626-770, Korea, luckyace@hanmail.net.
Abstract
BACKGROUND: A second-look endoscopy is routinely performed after endoscopic submucosal dissection (ESD) in many institutions, although the need is questionable. Additional hemostatic procedures might be necessary for the post-ESD ulcer with a high risk of bleeding. We investigated the predictive factors for post-ESD ulcers with a high risk of bleeding. METHODS: Second-look endoscopy was performed on the day following ESD. The post-ESD ulcers were categorized into two risk groups according to the Forrest classification: high-risk ulcer stigma (type I and IIa) and low-risk ulcer stigma. We analyzed the risk factors associated with high-risk ulcer stigma and late delayed bleeding. RESULTS: During the study period, 616 ESD procedures were performed. Second-look endoscopy revealed that the incidence of high-risk ulcer stigma post-ESD was 15.1%. Early and late delayed bleeding rates were 3.7 and 1.9%, respectively. Multivariate analysis revealed that submucosal fibrosis and nausea were significantly related to high-risk ulcer stigma after ESD. Multivariate analysis revealed that surface erosion, location of the lesion, and high-risk ulcer stigma identified by second-look endoscopy were significantly associated with late delayed bleeding. CONCLUSIONS: The effective use of selective second-look endoscopy will help limit unnecessary procedures. Submucosal fibrosis and nausea were risk factors associated with high-risk ulcer stigma after ESD.
BACKGROUND: A second-look endoscopy is routinely performed after endoscopic submucosal dissection (ESD) in many institutions, although the need is questionable. Additional hemostatic procedures might be necessary for the post-ESD ulcer with a high risk of bleeding. We investigated the predictive factors for post-ESD ulcers with a high risk of bleeding. METHODS: Second-look endoscopy was performed on the day following ESD. The post-ESD ulcers were categorized into two risk groups according to the Forrest classification: high-risk ulcer stigma (type I and IIa) and low-risk ulcer stigma. We analyzed the risk factors associated with high-risk ulcer stigma and late delayed bleeding. RESULTS: During the study period, 616 ESD procedures were performed. Second-look endoscopy revealed that the incidence of high-risk ulcer stigma post-ESD was 15.1%. Early and late delayed bleeding rates were 3.7 and 1.9%, respectively. Multivariate analysis revealed that submucosal fibrosis and nausea were significantly related to high-risk ulcer stigma after ESD. Multivariate analysis revealed that surface erosion, location of the lesion, and high-risk ulcer stigma identified by second-look endoscopy were significantly associated with late delayed bleeding. CONCLUSIONS: The effective use of selective second-look endoscopy will help limit unnecessary procedures. Submucosal fibrosis and nausea were risk factors associated with high-risk ulcer stigma after ESD.
Authors: R C Wong; A Chak; K Kobayashi; G A Isenberg; G S Cooper; D L Carr-Locke; M V Sivak Journal: Gastrointest Endosc Date: 2000-09 Impact factor: 9.427
Authors: Ho Yoel Ryu; Jae Woo Kim; Hyun-Soo Kim; Hong Jun Park; Hyo Keun Jeon; So Yeon Park; Bo Ra Kim; Cui Cui Lang; Sung Ho Won Journal: Gastrointest Endosc Date: 2013-03-24 Impact factor: 9.427
Authors: Ji Ha Kim; Hyeong Seok Nam; Cheol Woong Choi; Dae Hwan Kang; Hyung Wook Kim; Su Bum Park; Su Jin Kim; Sun Hwi Hwang; Si Hak Lee Journal: Surg Endosc Date: 2016-08-05 Impact factor: 4.584
Authors: Ja Jun Goo; Cheol Woong Choi; Dae Hwan Kang; Hyung Wook Kim; Su Bum Park; Mong Cho; Sun Hwi Hwang; Si Hak Lee Journal: Surg Endosc Date: 2015-04-17 Impact factor: 4.584