Second-look endoscopy is not associated with better clinical outcomes after gastric endoscopic submucosal dissection: A prospective, randomized, clinical trial analyzed on an as-treated basis

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

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Abstract

Background: The efficacy of routine second-look endoscopy (SLE) to detect or prevent bleeding after gastric endoscopic submucosal dissection (ESD) has not yet been validated. Objective: The aim of this study was to determine whether SLE affects clinical outcomes including bleeding and morbidity after gastric ESD. Design: A prospective, randomized, controlled study with consecutive data analyzed on an as-treated basis. Setting: A single, tertiary-care referral center. Patients: A total of 182 patients. Intervention: Gastric ESD and SLE. Main Outcome Measurements: Incidence of and risk factors related to bleeding after ESD and outcomes by univariate or multivariate analysis. Results: Among 182 patients enrolled, 74 and 81 patients were assigned to the SLE and no-SLE groups, respectively. Two groups were observed closely for 4 weeks. Bleeding occurred after ESD in 21 patients (13.5%). Hemoglobin loss (≥2.0 g/dL) was observed in 20 patients, and melena developed in 1 patient after ESD. However, only 1 patient needed a transfusion. Twelve patients (16.2%) in the SLE group and 9 in the no-SLE group (11.1%) experienced bleeding after ESD. The frequency of bleeding after ESD was not significantly different between the 2 groups (P =.66). There were no risk factors related to bleeding after ESD. Limitations: Single-center analysis. Conclusion: SLE is not routinely necessary because it does not affect clinical outcomes, including bleeding and morbidity after ESD. (Clinical trial registration number: KCT0000146.)

Original languageEnglish
Pages (from-to)285-294
Number of pages10
JournalGastrointestinal Endoscopy
Volume78
Issue number2
DOIs
Publication statusPublished - 2013 Aug 1

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Endoscopy
Stomach
Randomized Controlled Trials
Hemorrhage
Tertiary Care Centers
Endoscopic Mucosal Resection
Morbidity
Melena
Hemoglobins
Multivariate Analysis
Clinical Trials
Incidence

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

Cite this

Ryu, Ho Yoel ; Kim, Jae Woo ; Kim, Hyun Soo ; Park, Hong Jun ; Jeon, Hyo Keun ; Park, So Yeon ; Kim, Bo Ra ; Lang, Cui Cui ; Won, Sung Ho. / Second-look endoscopy is not associated with better clinical outcomes after gastric endoscopic submucosal dissection : A prospective, randomized, clinical trial analyzed on an as-treated basis. In: Gastrointestinal Endoscopy. 2013 ; Vol. 78, No. 2. pp. 285-294.
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abstract = "Background: The efficacy of routine second-look endoscopy (SLE) to detect or prevent bleeding after gastric endoscopic submucosal dissection (ESD) has not yet been validated. Objective: The aim of this study was to determine whether SLE affects clinical outcomes including bleeding and morbidity after gastric ESD. Design: A prospective, randomized, controlled study with consecutive data analyzed on an as-treated basis. Setting: A single, tertiary-care referral center. Patients: A total of 182 patients. Intervention: Gastric ESD and SLE. Main Outcome Measurements: Incidence of and risk factors related to bleeding after ESD and outcomes by univariate or multivariate analysis. Results: Among 182 patients enrolled, 74 and 81 patients were assigned to the SLE and no-SLE groups, respectively. Two groups were observed closely for 4 weeks. Bleeding occurred after ESD in 21 patients (13.5{\%}). Hemoglobin loss (≥2.0 g/dL) was observed in 20 patients, and melena developed in 1 patient after ESD. However, only 1 patient needed a transfusion. Twelve patients (16.2{\%}) in the SLE group and 9 in the no-SLE group (11.1{\%}) experienced bleeding after ESD. The frequency of bleeding after ESD was not significantly different between the 2 groups (P =.66). There were no risk factors related to bleeding after ESD. Limitations: Single-center analysis. Conclusion: SLE is not routinely necessary because it does not affect clinical outcomes, including bleeding and morbidity after ESD. (Clinical trial registration number: KCT0000146.)",
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Second-look endoscopy is not associated with better clinical outcomes after gastric endoscopic submucosal dissection : A prospective, randomized, clinical trial analyzed on an as-treated basis. / Ryu, Ho Yoel; Kim, Jae Woo; Kim, Hyun Soo; Park, Hong Jun; Jeon, Hyo Keun; Park, So Yeon; Kim, Bo Ra; Lang, Cui Cui; Won, Sung Ho.

In: Gastrointestinal Endoscopy, Vol. 78, No. 2, 01.08.2013, p. 285-294.

Research output: Contribution to journalArticle

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T1 - Second-look endoscopy is not associated with better clinical outcomes after gastric endoscopic submucosal dissection

T2 - A prospective, randomized, clinical trial analyzed on an as-treated basis

AU - Ryu, Ho Yoel

AU - Kim, Jae Woo

AU - Kim, Hyun Soo

AU - Park, Hong Jun

AU - Jeon, Hyo Keun

AU - Park, So Yeon

AU - Kim, Bo Ra

AU - Lang, Cui Cui

AU - Won, Sung Ho

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N2 - Background: The efficacy of routine second-look endoscopy (SLE) to detect or prevent bleeding after gastric endoscopic submucosal dissection (ESD) has not yet been validated. Objective: The aim of this study was to determine whether SLE affects clinical outcomes including bleeding and morbidity after gastric ESD. Design: A prospective, randomized, controlled study with consecutive data analyzed on an as-treated basis. Setting: A single, tertiary-care referral center. Patients: A total of 182 patients. Intervention: Gastric ESD and SLE. Main Outcome Measurements: Incidence of and risk factors related to bleeding after ESD and outcomes by univariate or multivariate analysis. Results: Among 182 patients enrolled, 74 and 81 patients were assigned to the SLE and no-SLE groups, respectively. Two groups were observed closely for 4 weeks. Bleeding occurred after ESD in 21 patients (13.5%). Hemoglobin loss (≥2.0 g/dL) was observed in 20 patients, and melena developed in 1 patient after ESD. However, only 1 patient needed a transfusion. Twelve patients (16.2%) in the SLE group and 9 in the no-SLE group (11.1%) experienced bleeding after ESD. The frequency of bleeding after ESD was not significantly different between the 2 groups (P =.66). There were no risk factors related to bleeding after ESD. Limitations: Single-center analysis. Conclusion: SLE is not routinely necessary because it does not affect clinical outcomes, including bleeding and morbidity after ESD. (Clinical trial registration number: KCT0000146.)

AB - Background: The efficacy of routine second-look endoscopy (SLE) to detect or prevent bleeding after gastric endoscopic submucosal dissection (ESD) has not yet been validated. Objective: The aim of this study was to determine whether SLE affects clinical outcomes including bleeding and morbidity after gastric ESD. Design: A prospective, randomized, controlled study with consecutive data analyzed on an as-treated basis. Setting: A single, tertiary-care referral center. Patients: A total of 182 patients. Intervention: Gastric ESD and SLE. Main Outcome Measurements: Incidence of and risk factors related to bleeding after ESD and outcomes by univariate or multivariate analysis. Results: Among 182 patients enrolled, 74 and 81 patients were assigned to the SLE and no-SLE groups, respectively. Two groups were observed closely for 4 weeks. Bleeding occurred after ESD in 21 patients (13.5%). Hemoglobin loss (≥2.0 g/dL) was observed in 20 patients, and melena developed in 1 patient after ESD. However, only 1 patient needed a transfusion. Twelve patients (16.2%) in the SLE group and 9 in the no-SLE group (11.1%) experienced bleeding after ESD. The frequency of bleeding after ESD was not significantly different between the 2 groups (P =.66). There were no risk factors related to bleeding after ESD. Limitations: Single-center analysis. Conclusion: SLE is not routinely necessary because it does not affect clinical outcomes, including bleeding and morbidity after ESD. (Clinical trial registration number: KCT0000146.)

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