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Role of second‐look endoscopy and prophylactic hemostasis after gastric endoscopic submucosal dissection: A systematic review and meta‐analysis
Author(s) -
Kim Eun Hye,
Park Se Woo,
Nam Eunwoo,
Eun Chang Soo,
Han Dong Soo,
Park Chan Hyuk
Publication year - 2017
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.13623
Subject(s) - medicine , hemostasis , endoscopy , odds ratio , surgery , endoscopic submucosal dissection , randomized controlled trial , meta analysis , incidence (geometry) , confidence interval , physics , optics
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], I 2 = 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], I 2 = 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.