Prevention, Identification, and Treatment of Perforation in the Lower Gastrointestinal Tract
Perforation is one of the most undesirable procedural complications associated with endoscopic submucosal dissection (ESD) and can be largely classified into those that occur during procedures, and those that have a delayed, postprocedural onset. Although intraprocedural perforations can be clipped and repaired, in cases where the gastrointestinal content has leaked into the abdominal cavity before any preemptive repair could be attempted, the potential for developing peritonitis becomes a grim and sobering possibility. Surgical repair (e.g. salvage laparotomy) is indicated in cases of postprocedural perforation. Conducting ESD via direct observation remains the paramount option for preventing this serious complication; however, even this does not guarantee a complication-free procedure and accidents can occur under the watch of some of the most experienced operators. Therefore, in order to effectively mitigate the inherent risk for perforation, a comprehensive pretreatment regimen and insufflation using carbon dioxide are absolutely imperative.
KeywordsPerforation Colorectal ESD Identification Treatment Prevention
- 4.Toyonaga T, Man-i M, Fujita T, East JE, Nishino E, Ono W, Morita Y, Sanuki T, Yoshida M, Kutsumi H, Inokuchi H, Azuma T. Retrospective study for technical aspects and complications of endoscopic submucosal dissection for laterally spreading tumors of the colorectum. Endoscopy. 2010;42:714–22.PubMedCrossRefGoogle Scholar