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Role of second-look endoscopy and prophylactic hemostasis after gastric endoscopic submucosal dissection: A systematic review and meta-analysis

 Eun Hye Kim  ;  Se Woo Park  ;  Eunwoo Nam  ;  Chang Soo Eun  ;  Dong Soo Han  ;  Chan Hyuk Park 
 Journal of Gastroenterology and Hepatology, Vol.32(4) : 756-768, 2017 
Journal Title
 Journal of Gastroenterology and Hepatology 
Issue Date
Databases, Bibliographic ; Endoscopy, Gastrointestinal* ; Gastric Mucosa/surgery* ; Gastrointestinal Hemorrhage/prevention & control* ; Hemostasis, Endoscopic* ; Humans ; Postoperative Complications/prevention & control* ; Randomized Controlled Trials as Topic ; Reoperation*
endoscopic submucosal dissection ; gastric neoplasm ; hemostasis ; prophylaxis ; second-look endoscopy
BACKGROUND: Although several studies have shown that second-look endoscopy does not affect the incidence of bleeding after gastric endoscopic submucosal dissection (ESD), the potential roles of second-look endoscopy have not been fully evaluated. This study aimed to determine the role of second-look endoscopy after ESD through a systematic review and meta-analysis. METHODS: This study conducted a systematic literature search of MEDLINE, EMBASE, and the Cochrane Library through March 2016 using the keywords "second-look," "prophylactic hemostasis," "prophylactic haemostasis," "prevention," "prophylaxis," and "endoscopic submucosal dissection." Studies were included if they evaluated the incidence of post-ESD bleeding according to second-look endoscopy or prophylactic hemostasis during second-look endoscopy. RESULTS: Four randomized controlled trials on post-ESD bleeding between second-look endoscopy and no second-look endoscopy and 12 non-randomized studies with a cohort design on post-ESD bleeding were included. On meta-analysis, second-look endoscopy did not affect delayed post-ESD bleeding (odds ratio [95% confidence interval] = 1.27 [0.80-2.00], I2 = 0%). During second-look endoscopy, patients who were considered as high-risk for post-ESD bleeding underwent prophylactic hemostasis. Delayed post-ESD bleeding was more common in patients who were treated with hemostasis during second-look endoscopy compared with those who were not (odds ratio [95% confidence interval] = 3.40 [1.87-6.18], I2 = 62%). In patients who underwent prophylactic hemostasis, the number needed to prolong a hospitalization period to avoid one additional post-ESD bleeding after discharge was 25. CONCLUSION: Second-look endoscopy after ESD could not reduce the risk of delayed post-ESD bleeding. Delayed post-ESD bleeding was more common in patients who underwent prophylactic hemostasis than in those who did not.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
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김은혜(Kim, Eun Hye) ORCID logo https://orcid.org/0000-0001-6691-6837
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