Surgical Endoscopy

, Volume 24, Issue 4, pp 911–916 | Cite as

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

  • Seong Woo Jeon
  • Min Kyu Jung
  • Sung Kook Kim
  • Kwang Bum Cho
  • Kyung Sik Park
  • Chang Keun Park
  • Joong Goo Kwon
  • Jin Tae Jung
  • Eun Young Kim
  • Tae Nyeun Kim
  • Byung Ik Jang
  • Chang Hun Yang
Article

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 

Notes

Disclosures

Drs. Seong Woo Jeon, Min Kyu Jung, Sung Kook Kim, Kwang Bum Cho, Kyung Sik Park, Chang Keun Park, Joong Goo Kwon, Eun Young Kim, Jin Tae Jung, Tae Nyeun Kim, Byung Ik Jang, and Chang Hun Yang have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    Soetikno R, Kaltenbach T, Yeh R, Gotoda T (2005) Endoscopic mucosal resection for early cancers of the upper gastrointestinal tract. J Clin Oncol 23:4490–4498CrossRefPubMedGoogle Scholar
  2. 2.
    Fujishiro M, Yahagi N, Kakushima N, Kodashima S, Muraki Y, Ono S, Kobayashi K, Hashimoto T, Yamamichi N, Tateishi A, Shimizu Y, Oka M, Ogura K, Kawabe T, Ichinose M, Omata M (2006) Successful nonsurgical management of perforation complicating endoscopic submucosal dissection of gastrointestinal epithelial neoplasms. Endoscopy 38:1001–1006CrossRefPubMedGoogle Scholar
  3. 3.
    Takizawa K, Oda I, Gotoda T, Yokoi C, Matsuda T, Saito Y, Saito D, Ono H (2008) Routine coagulation of visible vessels may prevent delayed bleeding after endoscopic submucosal dissection: an analysis of risk factors. Endoscopy 40:179–183CrossRefPubMedGoogle Scholar
  4. 4.
    Uedo N, Takeuchi Y, Yamada T, Ishihara R, Ogiyama H, Yamamoto S, Kato M, Tatsumi K, Masuda E, Tamai C, Yamamoto S, Higashino K, Iishi H, Tatsuta M (2007) Effect of a proton pump inhibitor or an H2-receptor antagonist on prevention of bleeding from ulcer after endoscopic submucosal dissection of early gastric cancer: a prospective randomized controlled trial. Am J Gastroenterol 102:1610–1616CrossRefPubMedGoogle Scholar
  5. 5.
    Ohkuwa M, Hosokawa K, Boku N, Ohtu A, Tajiri H, Yoshida S (2001) New endoscopic treatment for intramucosal gastric tumors using an insulated-tip diathermic knife. Endoscopy 33:221–226CrossRefPubMedGoogle Scholar
  6. 6.
    Yamamoto H, Kawata H, Sunada K, Satoh K, Kaneko Y, Ido K, Sugano K (2002) Success rate of curative endoscopic mucosal resection with circumferential mucosal incision assisted by submucosal injection of sodium hyaluronate. Gastrointest Endosc 56:507–512CrossRefPubMedGoogle Scholar
  7. 7.
    Oka S, Tanaka S, Kaneko I, Mouri R, Hirata M, Kawamura T, Yoshihara M, Chayama K (2006) Advantage of endoscopic submucosal dissection compared with EMR for early gastric cancer. Gastrointest Endosc 64:877–883CrossRefPubMedGoogle Scholar
  8. 8.
    Jeong G, Lee JH, Yu MK, Moon W, Rhee PL, Paik SW, Rhee JC, Kim JJ (2006) Nonsurgical management of microperforation induced by EMR of the stomach. Dig Liver Dis 38:605–608CrossRefPubMedGoogle Scholar
  9. 9.
    Kojima T, Parra-Blanco A, Takahashi H, Fujita R (1998) Outcome of endoscopic mucosal resection for early gastric cancer: review of the Japanese literature. Gastrointest Endosc 48:550–554; discussion 554–555PubMedGoogle Scholar
  10. 10.
    Minami S, Gotoda T, Ono H, Oda I, Hamanaka H (2006) Complete endoscopic closure of gastric perforation induced by endoscopic resection of early gastric cancer using endoclips can prevent surgery (with video). Gastrointest Endosc 63:596–601CrossRefPubMedGoogle Scholar
  11. 11.
    Ono H, Kondo H, Gotoda T, Shirao K, Yamaguchi H, Saito D, Hosokawa K, Shimoda T, Yoshida S (2001) Endoscopic mucosal resection for treatment of early gastric cancer. Gut 48:225–229CrossRefPubMedGoogle Scholar
  12. 12.
    Choi IJ, Kim CG, Chang HJ, Kim SG, Kook MC, Bae JM (2005) The learning curve for EMR with circumferential mucosal incision in treating intramucosal gastric neoplasm. Gastrointest Endosc 62:860–865CrossRefPubMedGoogle Scholar
  13. 13.
    Rosch T, Sarbia M, Schumacher B, Deinert K, Frimberger E, Toermer T, Stolte M, Neuhaus H (2004) Attempted endoscopic en bloc resection of mucosal and submucosal tumors using insulated-tip knives: a pilot series. Endoscopy 36:788–801CrossRefPubMedGoogle Scholar
  14. 14.
    Jeon SW, Jung MK, Cho CM, Tak WY, Kweon YO, Kim SK, Choi YH (2008) Predictors of immediate bleeding during endoscopic submucosal dissection in gastric lesions. Surg Endosc June 14, Epub ahead of printGoogle Scholar
  15. 15.
    Seewald S, Soehendra N (2006) Perforation: part and parcel of endoscopic resection? Gastrointest Endosc 63:602–605CrossRefPubMedGoogle Scholar
  16. 16.
    Bittinger M, Messmann H (2007) Is nonsurgical management safe and effective for patients with microperforation caused by EMR? Nat Clin Pract Gastroenterol Hepatol 4:134–135CrossRefPubMedGoogle Scholar
  17. 17.
    Kim JJ, Lee JH, Jung HY, Lee GH, Cho JY, Ryu CB, Chun HJ, Park JJ, Lee WS, Kim HS, Chung MG, Moon JS, Choi SR, Song GA, Jeong HY, Jee SR, Seol SY, Yoon YB (2007) EMR for early gastric cancer in Korea: a multicenter retrospective study. Gastrointest Endosc 66:693–700CrossRefPubMedGoogle Scholar
  18. 18.
    Takenaka R, Kawahara Y, Okada H, Hori K, Inoue M, Kawano S, Tanioka D, Tsuzuki T, Yagi S, Kato J, Uemura M, Ohara N, Yoshino T, Imagawa A, Fujiki S, Takata R, Yamamoto K (2008) Risk factors associated with local recurrence of early gastric cancers after endoscopic submucosal dissection. Gastrointest Endosc 68:887–894CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Seong Woo Jeon
    • 1
  • Min Kyu Jung
    • 1
  • Sung Kook Kim
    • 1
  • Kwang Bum Cho
    • 2
  • Kyung Sik Park
    • 2
  • Chang Keun Park
    • 3
  • Joong Goo Kwon
    • 4
  • Jin Tae Jung
    • 4
  • Eun Young Kim
    • 4
  • Tae Nyeun Kim
    • 5
  • Byung Ik Jang
    • 5
  • Chang Hun Yang
    • 6
  1. 1.Department of Internal MedicineKyungpook National University School of MedicineDaeguSouth Korea
  2. 2.Department of Internal MedicineKeimyung University College of MedicineDaeguSouth Korea
  3. 3.Department of Internal MedicineFatima HospitalDaeguSouth Korea
  4. 4.Department of Internal MedicineDaegu Catholic University School of MedicineDaeguSouth Korea
  5. 5.Department of Internal MedicineYoungnam University School of MedicineDaeguSouth Korea
  6. 6.Department of Internal MedicineDongguk University School of MedicineGyeongjuSouth Korea

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