Tu1457 Preventive Coagulation in 2nd-Look Endoscopy Reduces Delayed Bleeding After Gastric Endoscopic Submucosal Dissection

Abstract

Endoscopic submucosal dissection (ESD) is widely used for superficial gastrointestinal neoplasms, and the procedure has become well established. Major complications, such as ESD-related bleeding and perforation, have decreased with technical and procedural improvements. However, delayed bleeding still occurs in approximately 5% of patients who undergo gastric ESD. Preventive coagulation of visible vessels upon completion of ESD reportedly reduces delayed bleeding. In order to further reduce delayed bleeding, the preventive coagulation method must be improved.Therefore, we performed preventive coagulation during 2nd-look endoscopy in addition to the completion of ESD (double coagulation). We also investigated whether double coagulation reduces the frequency of delayed bleeding. We retrospectively analyzed 182 cases with 210 gastric lesions treated during the period from Sep 2007 through Sep 2010. The 2nd-look endoscopy was performed in all cases the day after ESD. Any exposed and/or oozing vessels were coagulated employing argon plasma coagulation (APC) regardless of whether bleeding was present. In 90 cases, we performed double coagulation while in the other 92 this procedure was considered to be unnecessary. We subsequently investigated the frequency of delayed bleeding during the 8 week period after ESD, during which patients were give proton pump inhibitor (PPI) therapy. Delayed bleeding occurred in 3 (1.4%) cases, 11-16 days after ESD (median, 13 days). The bleeding ulceration was located in the gastric body. All cases with delayed bleeding were in the non-double coagulation group. In our study, all delayed bleeding occurred in cases not receiving double coagulation. Therefore, preventive coagulation during 2nd-look endoscopy may reduce delayed bleeding. Because vessels are compressed and covered by submucosally injected solutions immediately after ESD, it is not possible to fully recognize such hidden vessels upon completion of ESD. However, on the day after ESD, the appearance of remnant vessels is more definitive. Thus, double coagulation of remnant vessels may contribute to reducing the frequency of delayed bleeding.