Second-look endoscopy is not associated with better clinical outcomes after gastric endoscopic submucosal dissection: a prospective, randomized, clinical trial analyzed on an as-treated basis

BackgroundThe efficacy of routine second-look endoscopy (SLE) to detect or prevent bleeding after gastric endoscopic submucosal dissection (ESD) has not yet been validated.ObjectiveThe aim of this study was to determine whether SLE affects clinical outcomes including bleeding and morbidity after gastric ESD.DesignA prospective, randomized, controlled study with consecutive data analyzed on an as-treated basis.SettingA single, tertiary-care referral center.PatientsA total of 182 patients.InterventionGastric ESD and SLE.Main Outcome MeasurementsIncidence of and risk factors related to bleeding after ESD and outcomes by univariate or multivariate analysis.ResultsAmong 182 patients enrolled, 74 and 81 patients were assigned to the SLE and no-SLE groups, respectively. Two groups were observed closely for 4 weeks. Bleeding occurred after ESD in 21 patients (13.5%). Hemoglobin loss (≥2.0 g/dL) was observed in 20 patients, and melena developed in 1 patient after ESD. However, only 1 patient needed a transfusion. Twelve patients (16.2%) in the SLE group and 9 in the no-SLE group (11.1%) experienced bleeding after ESD. The frequency of bleeding after ESD was not significantly different between the 2 groups (P = .66). There were no risk factors related to bleeding after ESD.LimitationsSingle-center analysis.ConclusionSLE is not routinely necessary because it does not affect clinical outcomes, including bleeding and morbidity after ESD. (Clinical trial registration number: KCT0000146.)