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A Multicenter Survey of the Management After Gastric Endoscopic Submucosal Dissection Related to Postoperative Bleeding

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Abstract

Background and Aims

Bleeding is a major complication after gastric endoscopic submucosal dissection (ESD). An evidence-based strategy for postoperative care related to delayed bleeding is required. We conducted a multicenter survey to assess the current status of management after gastric ESD.

Methods

A total of 1,814 gastric epithelial neoplasms in 2009 at ten tertiary referral centers were enrolled. The current status of the management after gastric ESD (use of an antisecretory drug, food intake, and second-look endoscopy) at participating hospitals was assessed. Furthermore, the rate of post-ESD bleeding and the differences in each parameter were retrospectively analyzed.

Results

Postoperative bleeding occurred in 100 cases (5.5%), which included 62 cases of bleeding within 24 h after ESD. In all of the hospitals, proton pump inhibitors (PPIs) were used. The median administration period was 56 days (range 14–60 days). Food intake was resumed from postoperative day (POD) 1 in 4 hospitals and from POD 2 in 6 hospitals. Second-look endoscopy was performed for almost all cases, fewer cases, and rarely or none in 6, 2, and 2 hospitals, respectively. The day of second-look endoscopy varied among hospitals. There was no statistical relationship between the postoperative bleeding rate and the differences in these three parameters.

Conclusions

Post-ESD management (duration of PPI use, resumption of food intake, and performance of second-look endoscopy) varied among the medical centers; thus, randomized controlled trials are required for an optimal strategy after gastric ESD.

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Authors and Affiliations

  1. Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan

    Osamu Goto & Kazuhiko Koike

  2. Department of Endoscopy and Endoscopic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

    Mitsuhiro Fujishiro

  3. Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan

    Ichiro Oda

  4. Endoscopy Division, Shizuoka Cancer Center, Shizuoka, Japan

    Naomi Kakushima

  5. Department of Gastroenterology, Cancer Institute Hospital, Tokyo, Japan

    Yorimasa Yamamoto

  6. Department of Gastroenterology, NTT Medical Center Tokyo, Tokyo, Japan

    Yosuke Tsuji & Ken Ohata

  7. Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan

    Takashi Fujiwara & Junko Fujiwara

  8. Department of Gastroenterology, St Luke’s International Hospital, Tokyo, Japan

    Naoki Ishii

  9. Department of Gastroenterology, National Center for Global Health and Medicine, Tokyo, Japan

    Chizu Yokoi & Takuji Gotoda

  10. Department of Gastroenterology, The University of Kyoto, Kyoto, Japan

    Shinichi Miyamoto & Toshiyuki Itoh

  11. Department of Gastroenterology, Tokyo Koseinenkin Hospital, Tokyo, Japan

    Shinji Morishita

Authors
  1. Osamu Goto
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  2. Mitsuhiro Fujishiro
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  3. Ichiro Oda
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  4. Naomi Kakushima
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  5. Yorimasa Yamamoto
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  6. Yosuke Tsuji
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  7. Ken Ohata
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  8. Takashi Fujiwara
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  9. Junko Fujiwara
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  10. Naoki Ishii
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  11. Chizu Yokoi
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  12. Shinichi Miyamoto
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  13. Toshiyuki Itoh
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  14. Shinji Morishita
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  15. Takuji Gotoda
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  16. Kazuhiko Koike
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Corresponding author

Correspondence to Osamu Goto.

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Goto, O., Fujishiro, M., Oda, I. et al. A Multicenter Survey of the Management After Gastric Endoscopic Submucosal Dissection Related to Postoperative Bleeding. Dig Dis Sci 57, 435–439 (2012). https://doi.org/10.1007/s10620-011-1886-5

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  • DOI: https://doi.org/10.1007/s10620-011-1886-5

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