Usefulness of the Forrest Classification to Predict Artificial Ulcer Rebleeding during Second-Look Endoscopy after Endoscopic Submucosal Dissection
- Authors
- Kim, Duk Su; Jung, Yunho; Rhee, Ho Sung; Lee, Su Jin; Jo, Yeong Geol; Kim, Jong Hwa; Park, Jae Man; Chung, Il-Kwun; Cho, Young Sin; Lee, Tae Hoon; Park, Sang-Heum; Kim, Sun-Joo
- Issue Date
- May-2016
- Publisher
- 대한소화기내시경학회
- Keywords
- Stomach neoplasms; Hemorrhage; Hemostasis; endoscopic
- Citation
- Clinical Endoscopy, v.49, no.3, pp 273 - 281
- Pages
- 9
- Journal Title
- Clinical Endoscopy
- Volume
- 49
- Number
- 3
- Start Page
- 273
- End Page
- 281
- URI
- https://scholarworks.bwise.kr/sch/handle/2021.sw.sch/9185
- DOI
- 10.5946/ce.2015.086
- ISSN
- 2234-2400
2234-2443
- Abstract
- Background/Aims: Delayed post-endoscopic submucosal dissection (ESD) bleeding (DPEB) is difficult to predict and there is controversy regarding the usefulness of prophylactic hemostasis during second-look endoscopy. This study evaluated the risk factors related to DPEB, the relationship between clinical outcomes and the Forrest classification, and the results of prophylactic hemostasis during second-look endoscopy. Methods: Second-look endoscopy was performed on the day after ESD to check for recent hemorrhage or potential bleeding and the presence of artificial ulcers in all patients. Results: DPEB occurred in 42 of 581 patients (7.2%). Multivariate analysis determined that a specimen size >= 40 mm (odds ratio [OR], 3.03; p=0.003), and a high-risk Forrest classification (Forrest Ib+IIa+IIb; OR, 6.88; p<0.001) were risk factors for DPEB. DPEB was significantly more likely in patients classified with Forrest Ib (OR, 24.35; p<0.001), IIa (OR, 12.91; p<0.001), or IIb (OR, 8.31; p<0.001) ulcers compared with Forrest III ulcers. There was no statistically significant difference between the prophylactic hemostasis and nonhemostasis groups (Forrest Ib, p=0.938; IIa, p=0.438 ;IIb, p=0.397; IIc, p=0.773) during second-look endoscopy. Conclusions: The Forrest classification of artificial gastric ulcers during second-look endoscopy seems to be a useful tool for predicting delayed bleeding. However, routine prophylactic hemostasis during second-look endoscopy seemed to not be useful for preventing DPEB.
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Collections - College of Medicine > Department of Internal Medicine > 1. Journal Articles
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