PT  - JOURNAL ARTICLE
AU  - Satoshi Mochizuki
AU  - Noriya Uedo
AU  - Ichiro Oda
AU  - Kazuhiro Kaneko
AU  - Yorimasa Yamamoto
AU  - Takeshi Yamashina
AU  - Haruhisa Suzuki
AU  - Shinya Kodashima
AU  - Tomonori Yano
AU  - Nobutake Yamamichi
AU  - Osamu Goto
AU  - Takeshi Shimamoto
AU  - Mitsuhiro Fujishiro
AU  - Kazuhiko Koike
TI  - Scheduled second-look endoscopy is not recommended after endoscopic submucosal dissection for gastric neoplasms (the SAFE trial): a multicentre prospective randomised controlled non-inferiority trial
AID  - 10.1136/gutjnl-2014-307552
DP  - 2015 Mar 01
TA  - Gut
PG  - 397--405
VI  - 64
IP  - 3
4099  - http://gut.bmj.com/content/64/3/397.short
4100  - http://gut.bmj.com/content/64/3/397.full
SO  - Gut2015 Mar 01; 64
AB  - Objective To clarify the effectiveness of second-look endoscopy (SLE) at preventing bleeding after gastric endoscopic submucosal dissection (ESD). Design A multicentre prospective randomised controlled non-inferiority trial was conducted at five referral institutions across Japan. Patients with a solitary gastric neoplasm were enrolled. Exclusion criteria were previous oesophagogastric surgery or radiation therapy; perforation and the administration of antithrombotics, steroids or non-steroidal anti-inflammatory drugs. Patients were assigned to the SLE group or the non-SLE group by a computer-generated random sequence after ESD and were treated perioperatively with a proton pump inhibitor. SLE was performed one day after ESD. The primary endpoint was post-ESD bleeding, defined as an endoscopically proven haemorrhage. The trial had the power to detect a non-inferiority criterion of 7% between the groups. Results From February 2012 to February 2013, 130 and 132 patients were assigned to the SLE and the non-SLE groups, respectively. All patients were included in the intention-to-treat analysis of the primary endpoint. Post-ESD bleeding occurred in seven patients with (5.4%) SLE and five patients with (3.8%) non-SLE (risk difference −1.6% (95% CI −6.7 to 3.5); pnon-inferiority<0.001), meeting the non-inferiority criterion. All 12 patients with post-ESD bleeding and one patient with a delayed perforation were successfully managed with conservative treatment. Conclusions SLE after gastric ESD is not routinely recommended because it does not contribute to the prevention of post-ESD bleeding for patients with an average bleeding risk. Trial registration number UMIN-CTR000007170.