Journal
GUT
Volume 64, Issue 3, Pages 397-405Publisher
BMJ PUBLISHING GROUP
DOI: 10.1136/gutjnl-2014-307552
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Funding
- Astellas Pharmaceutical
- Takeda Pharmaceutical
- Zeria Pharmaceutical
- Otsuka Pharmaceutical
- AstraZeneca Pharmaceutical
- Dainihon-Sumitomo Pharmaceutical
- Taiho Pharmaceutical
- Ajinomoto Pharmaceutical
- Daiichi-Sankyo Pharmaceutical
- Aska Pharmaceutical
- Eisai
- Grants-in-Aid for Scientific Research [25460381] Funding Source: KAKEN
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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); p(non-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.
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