Second-look endoscopy and factors associated with delayed bleeding after endoscopic submucosal dissection

Table 2 Incidence of delayed bleeding and associated risk factors after gastric endoscopic submucosal dissection

Ref.	Year	n	Study design	Bleeding (%)	Risk factors	Remarks
Takizawa et al[5]	2008	968	Retrospective	5.8% (7.1% vs 3.1% with PEC)	Tumor location in middle and lower regions of the stomach, PEC	PEC of visible vessels in the resected area follwing ESD may lead to a decreased bleeding rate
Chung et al[30]	2009	952	Retrospective	15.60%	Upper region, size of the tumor (> 40 mm), recurrent lesion, flat morphology	A significant bleeding incidence was at 0.6%
Okada et al[10]	2011	582	Retrospective	4.81%	Resected specimen width (≥ 40 mm)	Mechanism of delayed bleeding may differ depending on the time elapsed between ESD and bleeding episodes
Toyokawa et al[11]	2012	1123	Retrospective	5.00%	Age ≥ 80 yr, extended duration of procedure	-
Goto et al[9]	2012	1814	Retrospective	5.50%	No statistical parameters	Multicenter survey clarified that post-ESD management (duration of PPI use, resumption of food intake, and performance of SLE) varied among the medical centers
Koh et al[12]	2013	1032	Retrospective	5.30%	Size of resected specimen	The incidence of delayed bleeding in patients with two risk factors was 11.6%
Choi et al[3]	2014	614	Prospective observation	Early (3.7%) Late (1.9%)	(> 40 mm), use of antithrombotic drugs (only for delay bleeding) Surface erosion, high risk of stigmata during SLE, location in the middle of the stomach	Nausea and submucosal fibrosis increase the incidence of high risk of stigmata in SLE

PEC: Post-endoscopic submucosal dissection coagulation; ESD: Endoscopic submucosal dissection; PPI: Proton pump inhibitor; SLE: Second-look endoscopy.