Effectiveness of second-look endoscopy after gastric endoscopic submucosal dissection in patients taking antithrombotic agents: a multicenter propensity score matching analysis

Effectiveness of nasogastric tube decompression in mitigating delayed bleeding following endoscopic submucosal dissection for early gastric cancers

BACKGROUND AND AIMS

Nasogastric tube decompression (NGTD) has been a standard practice following endoscopic submucosal dissection (ESD) for early gastric cancers (EGCs) in clinical settings for several years. Nevertheless, there remains a dearth of research assessing the efficacy of NGTD in preventing delayed bleeding after ESD.

METHODS

From January 2021 to December 2022, eligible patients who underwent gastric ESD for EGCs were categorized into two groups: NGTD group and no NGTD group. A retrospective Propensity Score Matching (PSM) study was performed to analyzed the data.

RESULTS

The delayed bleeding rate did not exhibit a significant decrease in the NGTD group, when compared with the no NGTD group. In the multivariate analysis, the size of the resected lesion emerged as the sole predictive factor for delayed bleeding after ESD, as opposed to the use of NGTD. Moreover, our findings revealed that hospital stay and costs were higher in the NGTD group. (8 days vs 7 days, p = 0.033, 3348.19$ vs 2840.28$, p = 0.00, respectively).

CONCLUSION

The utilization of NGTD showed no significant impact on delayed bleeding after ESD for EGCs and was correlated with hospital stay and costs. Therefore, the routine application of NGTD following ESD for EGCs may not be deemed necessary.

Management of delayed bleeding of upper gastrointestinal endoscopic submucosal tunneling procedures: a retrospective single-center analysis and brief meta-analysis

OBJECTIVES

Delayed bleeding is a rare but important major adverse event (mAE) after endoscopic submucosal tunneling procedures (ESTP), which is scarcely reported. We aimed to characterize the clinical characteristics of delayed bleeding and provide better management of this mAE.

METHOD

From August 2010 to October 2022, we reviewed 3852 patients with achalasia receiving peroral endoscopic myotomy (POEM) and 1937 patients with upper gastrointestinal tumors receiving submucosal tunneling endoscopic resection (STER). Among these, records of 22 patients (15 POEM, 7 STER) with delayed bleeding were collected. Clinical characteristics, treatment, and outcomes of delayed bleeding were analyzed.

RESULTS

The mean age was 43.6 years. Ten patients (45.5%) were intratunnel bleeding, seven (31.8%) were intratunnel bleeding accompanied by mucosal bleeding, and five (22.7%) were mucosal bleeding. The most common accompanied symptoms were hematemesis, fever, and melena. The most common accompanied mAEs were fistula, pulmonary inflammation, and pleural effusion with atelectasis. The mean duration from ESTP to endoscopic intervention was 5.3 ± 4.9 days. Active bleeding was identified in 21 patients (95.5%). The bleeding was successfully controlled by electrocoagulation (19 cases), endoscopic clipping (six cases), and Sengstaken-Blakemore tube insertion (three cases), and no patient required surgical intervention. The mean hemostatic procedure duration was 61.8 ± 45.8 min. The mean post-bleeding hospital stay was 10.0 ± 6.2 days. A brief meta-analysis of previous studies showed the pooled estimate delayed bleeding rate after POEM, STER, and G-POEM was 0.4%.

CONCLUSIONS

Delayed bleeding is uncommon and could be effectively managed by timely emergency endoscopic procedures without requiring subsequent surgical interventions.