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©The Author(s) 2020.
World J Gastroenterol. Nov 7, 2020; 26(41): 6475-6487
Published online Nov 7, 2020. doi: 10.3748/wjg.v26.i41.6475
Published online Nov 7, 2020. doi: 10.3748/wjg.v26.i41.6475
Table 1 Baseline characteristics and treatment outcome of the third-look endoscopy group
| TLE group (n = 114) | TLE group (n = 114) | ||
| Age, mean ± SD (yr) | 75.5 ± 0.6 | En-bloc resection, % (n) | 100 (114) |
| Sex | R0 resection, % (n) | 100 (114) | |
| Male, % (n) | 86.0 (98) | Curative resection, % (n) | 90.4 (103) |
| Female, % (n) | 14.0 (16) | Median procedure time (range) | 41.5 (10-180) |
| Location-1 | SLE Hemostasis, % (n) | 68.8 (77) | |
| Upper, % (n) | 18.4 (21) | Forrest classification 1b, % (n) | 10.7 (12) |
| Middle, % (n) | 12.3 (14) | Forrest classification 2a, % (n) | 58.0 (65) |
| Lower, % (n) | 69.3 (79) | TLE Hemostasis, % (n) | 35.7 (40) |
| Location-2 | Forrest classification 1b, % (n) | 10.7 (12) | |
| Anterior wall, % (n) | 8.8 (10) | Forrest classification 2a, % (n) | 25.0 (28) |
| Posterior wall, % (n) | 31.6 (36) | The day of TLE, % (n) | |
| Lesser curvature, % (n) | 40.3 (46) | POD 4 | 29.8 (34) |
| Greater curvature, % (n) | 19.3 (22) | POD 5 | 54.4 (62) |
| Morphology | POD 6 | 14.0 (16) | |
| Protruded, % (n) | 42.9 (49) | Comorbidities | |
| Flat/depressed, % (n) | 57.0 (65) | Hypertension, % (n) | 85.1 (97) |
| Median tumor size (range) | 11.0 (2-70) | Diabetes mellitus, % (n) | 21.9 (25) |
| Median specimen size (range) | 35.0 (18-95) | Hyperlipidemia, % (n) | 54.4 (62) |
| Synchronous occurrence, % (n) | 22.9 (22/96 patients) | Cardiac disease, % (n) | 69.3 (79) |
| Ulcerative findings | Cerebral infarction, % (n) | 24.6 (28) | |
| (+), % (n) | 5.3 (6) | Hemodialysis, % (n) | 3.5 (4) |
| (-) , % (n) | 94.7 (108) | Receiving antithrombotic agents | |
| Depth of invasion | Continue, % (n) | 100 (114) | |
| M/SM1, % (n) | 98.2 (112) | Discontinue, % (n) | 0 (0) |
| SM2-, % (n) | 1.8 (2) | Antithrombotic agents | |
| Pathological finding | Aspirin, % (n) | 43.9 (50) | |
| Differentiated type, % (n) | 95.6 (109) | Thienopyridine, % (n) | 10.5 (12) |
| Undifferentiated type, % (n) | 4.4 (5) | Cilostazol, % (n) | 5.3 (6) |
| lymphovascular infiltration | Warfarin, % (n) | 2.6 (3) | |
| (+), % (n) | 4.4 (5) | DOAC, % (n) | 20.2 (23) |
| (-) , % (n) | 95.6 (109) | Multiple antithrombotic agents, % (n) | 17.5 (20) |
Table 2 Postoperative delayed bleeding rate of the third-look endoscopy group (primary endpoint)
| TLE group, n = 114 | 90%CI | P value | Threshold (%) | |
| Overall PDB, % (n) | 7.9 (9) | 4.7-13.1 | 0.005 | 15.3 |
| Early phase (E-PDB), % (n) | 2.6 (3) | 1.1-6.4 | 0.51 | 3.8 |
| Late phase (L-PDB), % (n) | 5.3 (6) | 2.7-9.9 | < 0.0001 | 11.5 |
Table 3 Baseline characteristics of the third-look endoscopy and control group before propensity score matching
| TLE (n = 114) | Control (n = 132) | P value | |
| Age, mean ± SD (yr) | 75.5 ± 6.2 | 76.2 ± 6.5 | 0.37 |
| Sex | 0.68 | ||
| Male, % (n) | 86.0 (98) | 84.1 (111) | |
| Female, % (n) | 14.0 (16) | 15.9 (21) | |
| Location-1 | 0.51 | ||
| Upper, % (n) | 18.4 (21) | 15.2 (20) | |
| Middle, % (n) | 12.3 (14) | 13.6 (18) | |
| Lower, % (n) | 69.3 (79) | 71.2 (94) | |
| Location-2 | 0.005 | ||
| Anterior wall, % (n) | 8.8 (10) | 25.0 (33) | |
| Posterior wall, % (n) | 31.6 (36) | 19.7 (26) | |
| Lesser curvature, % (n) | 40.4 (46) | 37.9 (50) | |
| Greater curvature, % (n) | 19.3 (22) | 17.4 (23) | |
| Morphology | 0.53 | ||
| Protruded, % (n) | 43.0 (49) | 47.0 (62) | |
| Flat/depressed, % (n) | 57.0 (65) | 53.0 (70) | |
| Median tumor size (range) | 11.0 (2-70) | 12.0 (3-60) | 0.77 |
| Median specimen size (range) | 35.0 (18-95) | 35.0 (15-97) | 0.89 |
| Ulcerative findings | 0.79 | ||
| (+), % (n) | 5.3 (6) | 4.6 (6) | |
| (-), % (n) | 94.7 (108) | 95.5 (126) | |
| Depth of invasion | 0.09 | ||
| M/SM1, % (n) | 98.3 (112) | 93.9 (124) | |
| SM2-, % (n) | 1.8 (2) | 6.1 (8) | |
| Pathological finding | 0.07 | ||
| Differentiated type, % (n) | 95.6 (109) | 99.2 (131) | |
| Undifferentiated type, % (n) | 4.4 (5) | 0.8 (1) | |
| Lymphovascular infiltration | 0.74 | ||
| (+), % (n) | 4.4 (5) | 5.3 (7) | |
| (-), % (n) | 95.6 (109) | 94.7 (125) | |
| Median procedure time (range) | 41.5 (10-180) | 42.0 (7-215) | 0.84 |
| Receiving antithrombotic agents | < 0.0001 | ||
| Continue, % (n) | 100 (114) | 43.9 (58) | |
| Discontinue, % (n) | 0 (0) | 56.1 (74) |
Table 4 Baseline characteristics of the third-look endoscopy and control group after propensity score matching
| TLE (n = 58) | Control (n = 58) | P value | |
| Age, mean ± SD (yr) | 75.8 ± 6.4 | 77.7 ± 6.5 | 0.10 |
| Sex | 0.59 | ||
| Male, % (n) | 84.5 (49) | 87.9 (51) | |
| Female, % (n) | 15.5 (9) | 12.1 (7) | |
| Location-1 | 0.52 | ||
| Upper, % (n) | 19.0 (11) | 13.8 (8) | |
| Middle, % (n) | 6.9 (4) | 12.1 (7) | |
| Lower, % (n) | 74.1 (43) | 74.1 (43) | |
| Location-2 | 0.14 | ||
| Anterior wall, % (n) | 12.1 (7) | 24.1 (14) | |
| Posterior wall, % (n) | 34.5 (20) | 19.0 (11) | |
| Lesser curvature, % (n) | 34.5 (20) | 41.4 (24) | |
| Greater curvature, % (n) | 19.0 (11) | 15.5 (9) | |
| Morphology | 0.35 | ||
| Protruded, % (n) | 46.6 (27) | 55.2 (32) | |
| Flat/depressed, % (n) | 53.5 (31) | 44.8 (26) | |
| Median tumor size (range) | 9.5 (2-40) | 11.0 (3-43) | 0.54 |
| Median specimen size (range) | 34 (18-60) | 33 (17-78) | 0.71 |
| Ulcerative findings | 1.00 | ||
| (+), % (n) | 1.7 (1) | 1.7 (1) | |
| (-), % (n) | 98.3 (57) | 98.3 (57) | |
| Depth of invasion | 0.17 | ||
| M/SM1, % (n) | 98.3 (57) | 93.1 (54) | |
| SM2-, % (n) | 1.7 (1) | 6.9 (4) | |
| Pathological finding | - | ||
| Differentiated type, % (n) | 100 (58) | 100 (58) | |
| Undifferentiated type, % (n) | 0 (0) | 0 (0) | |
| Lymphovascular infiltration | 1.00 | ||
| (+), % (n) | 3.5 (2) | 3.5 (2) | |
| (-), % (n) | 96.6 (56) | 96.6 (56) | |
| Median procedure time (range) | 36.0 (10-78) | 37.0 (8-175) | 0.14 |
| Receiving antithrombotic agents | - | ||
| Continue, % (n) | 100 (58) | 100 (58) | |
| Discontinue, % (n) | 0 (0) | 0 (0) |
Table 5 Comparative analysis of the postoperative delayed bleeding rate in the third-look endoscopy and control group (secondary endpoint)
| TLE (n = 58) | Control (n = 58) | P value | |
| Overall PDB rate, % (n) | 10.3 (6) | 20.7 (12) | 0.12 |
| Early phase(E-PDB), % (n) | 5.2 (3) | 3.5 (2) | 1 |
| Late phase(L-PDB) , % (n) | 5.2 (3) | 17.2 (10) | 0.04 |
Table 6 Postoperative delayed bleeding rate by each drug in third-look endoscopy (n = 114) and control (n = 132) group
| Overall | E-PDB | L-PDB | ||||
| TLE | Control | TLE | Control | TLE | Control | |
| Aspirin, % (n) | 6.0 (3/50) | 3.4 (2/59) | 2.0 (1/50) | 3.4 (2/59) | 4.0 (2/50) | 0 (0/59) |
| Thienopyridine, % (n) | 8.3 (1/12) | 9.1 (1/11) | 0 (0/12) | 0 (0/11) | 8.3 (1/12) | 9.1 (1/11) |
| Cilostazol, % (n) | 0 (0/6) | 0 (0/14) | 0 (0/6) | 0 (0/14) | 0 (0/6) | 0 (0/14) |
| Warfarin, % (n) | 0 (0/3) | 0 (0/1) | 0 (0/3) | 0 (0/1) | 0 (0/3) | 0 (0/1) |
| DOAC, % (n) | 13.0 (3/23) | 23.1 (3/13) | 4.3 (1/23) | 0 (0/13) | 8.7 (2/23) | 23.1 (3/13) |
| Multiple antithrombotic agents, % (n) | 10.0 (2/20) | 32.4 (11/34) | 5.0(1/20) | 2.9 (1/34) | 5.0 (1/20) | 29.4 (10/34) |
- Citation: Ikeda R, Hirasawa K, Sato C, Ozeki Y, Sawada A, Nishio M, Fukuchi T, Kobayashi R, Makazu M, Taguri M, Maeda S. Third-look endoscopy prevents delayed bleeding after endoscopic submucosal dissection under antithrombotic therapy. World J Gastroenterol 2020; 26(41): 6475-6487
- URL: https://www.wjgnet.com/1007-9327/full/v26/i41/6475.htm
- DOI: https://dx.doi.org/10.3748/wjg.v26.i41.6475