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Clinical outcomes for perforations during endoscopic submucosal dissection in patients with gastric lesions

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Author(s)
조광범박경식
Alternative Author(s)
Cho, Kwang BumPark, Kyung Sik
Issued Date
2010
Keyword
Gastroscopic surgical procedurePneumoperitoneumStomach neoplasia
Abstract
Background The endoscopic submucosal dissection
(ESD) technique has been gaining popularity, with continued
advances in this treatment approach. However, ESD
still is associated with potential complications such as
severe bleeding and perforation.
Methods This study was performed to compare the clinical
outcomes for macro- and microperforations with ESD
procedures and to determine the short-term prognosis after
ESD. A macroperforation was defined as a gross perforation
that occurred during an ESD procedure, and a microperforation
was defined by free air observed on simple
radiography after the procedure. Immediate closure of
macroperforations was performed using endoclips. From
July 2003 through May 2008, 1,711 patients underwent
ESD for gastric lesions such as dysplasia, early cancer, and
subepithelial lesions.
Results Among 39 perforation cases (2.3%), macroperforations
occurred for 26 patients (67%) and microperforations
for 13 patients (33%). All the patients except one
who underwent emergency surgery because of severe
bleeding and perforation during ESD were managed successfully
by intravenous antibiotics and no oral intake. The
clinical prognosis and endoscopic characteristics of the
patients with macroperforations did not differ from those of
the patients with microperforations.
Conclusions Perforations associated with ESD could be
managed safely and successfully by nonsurgical methods.
The clinical prognoses for macro- and microperforations
were favorable and comparable.
Keywords Gastroscopic surgical procedure
Pneumoperitoneum Stomach neoplasia Endoscopic submucosal dissection (ESD) is widely accepted
in Korea and Japan as an alternative to surgery for the
complete resection of gastric lesions [1]. The ESD procedure
is regarded as more effective than other endoscopic methods
for the treatment of gastric lesions because it provides en
bloc specimens for pathologic evaluation. Compared with
open surgery, ESD is relatively noninvasive. This has made
it a desirable technique. However, significant complications
have been associated with ESD [2–4].
Bleeding is a more common complication of ESD than
of endoscopic mucosal resection (EMR). The frequency of
bleeding, reported to be 7% to 38%, has been associated with the site of the lesions [5–7]. In addition, the perforation
frequency is reported to be higher with the ESD (4%)
than with EMR (0.5%) [8, 9]. These complications have
limited the use of ESD, although it provides en bloc
complete resection samples. Several recent studies have
shown that the recovery rate for patients who have iatrogenic
perforations associated with ESD treated conservatively
was the same as for patients without such
complications [2, 8, 10].
Perforations that occur in relation to ESD are divided
into macro- and microperforations. Macroperforations
usually are noted during the procedure and can be treated
successfully with endoclips. However, microperforations
usually are diagnosed by free air on plain x-rays after the
procedure.
Currently, very little information exists on the outcome
for patients with these two types of perforations. Therefore,
in this study, we investigated the frequency and clinical
outcomes for macro- and microperforations in a large
series of patients undergoing ESDs.
Department
Dept. of Internal Medicine (내과학)
Publisher
School of Medicine
Citation
Surgical Endoscopy, Vol.24(4) : 911-916, 2010
Type
Article
ISSN
0930-2794
DOI
10.1007/s00464-009-0693-y
URI
http://kumel.medlib.dsmc.or.kr/handle/2015.oak/34440
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
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