Usefulness of the Forrest Classification to Predict Artificial Ulcer Rebleeding during Second-Look Endoscopy after Endoscopic Submucosal Dissection.
- Author:
Duk Su KIM
1
;
Yunho JUNG
;
Ho Sung RHEE
;
Su Jin LEE
;
Yeong Geol JO
;
Jong Hwa KIM
;
Jae Man PARK
;
Il Kwun CHUNG
;
Young Sin CHO
;
Tae Hoon LEE
;
Sang Heum PARK
;
Sun Joo KIM
Author Information
- Publication Type:Original Article
- Keywords: Stomach neoplasms; Hemorrhage; Hemostasis, endoscopic
- MeSH: Classification*; Endoscopy*; Hemorrhage; Hemostasis; Hemostasis, Endoscopic; Humans; Multivariate Analysis; Risk Factors; Stomach Neoplasms; Stomach Ulcer; Ulcer*
- From:Clinical Endoscopy 2016;49(3):273-281
- CountryRepublic of Korea
- Language:English
- 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 non-hemostasis 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.
