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- Title
Role of second-look endoscopy and prophylactic hemostasis after gastric endoscopic submucosal dissection: A systematic review and meta-analysis.
- Authors
Kim, Eun Hye; Park, Se Woo; Nam, Eunwoo; Eun, Chang Soo; Han, Dong Soo; Park, Chan Hyuk
- Abstract
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.
- Subjects
ENDOSCOPY; DISSECTION; HEMORRHAGE; MEDLINE; HEMOSTASIS
- Publication
Journal of Gastroenterology & Hepatology, 2017, Vol 32, Issue 4, p756
- ISSN
0815-9319
- Publication type
Article
- DOI
10.1111/jgh.13623