Hyun Ju Kim1,2,3, Hyunsoo Chung4,5,6, Da Hyun Jung1,2, Jun Chul Park1,2, Sung Kwan Shin1,2, Sang Kil Lee1,2, Yong Chan Lee1,2. 1. Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea. 2. Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea. 3. Yonsei University Graduate School of Medicine, Seoul, Korea. 4. Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea. hchung@yuhs.ac. 5. Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea. hchung@yuhs.ac. 6. Yonsei University Graduate School of Medicine, Seoul, Korea. hchung@yuhs.ac.
Abstract
INTRODUCTION: Perforation is one of the major complications of endoscopic submucosal dissection (ESD). In the present study, we investigated the clinical outcomes of and management strategies for ESD-related perforations. METHODS: Between February 2010 and April 2014, a total of 3821 patients who underwent ESD for an upper gastrointestinal epithelial neoplasm were analyzed using the Yonsei University Severance Hospital database. Clinical outcomes of and management strategies for perforations in 90 patients (2.4 %) were analyzed. The risk factors for the development of perforation were also investigated. RESULTS: The mean age of our subjects was 64.7 ± 12.2 years (male to female ratio, 3.2:1), and the mean size of the resected specimens was 39.4 ± 12.5 mm. Endoscopically visible perforations (visible perforation group) were noted in 74 of the 90 patients (82.2 %), and clinically suspected perforations (suspected perforation group) were noted in 16 patients (17.8 %). Immediate closure with endoclips was attempted in cases with a visible perforation and was successful in 72 (97.3 %) cases. Two patients in whom endoscopic closure failed underwent surgery. Conservative care, including fasting and intravenous antibiotic administration, was attempted in the suspected perforation group, and all the patients were treated successfully without surgery. The mean durations of fasting, antibiotic treatment, and hospital stay were 3.8 ± 3.1, 6.8 ± 4.2, and 8.7 ± 5.3 days, respectively. Subgroup analysis of perforation type (visible perforation vs. suspected perforation) revealed no significant difference in the clinical course. Tumor location at the upper or middle third of the stomach was significantly associated with perforation. CONCLUSION: Most of the ESD-related perforations in upper gastrointestinal epithelial neoplasm could be managed successfully in a non-surgical manner under strict monitoring.
INTRODUCTION: Perforation is one of the major complications of endoscopic submucosal dissection (ESD). In the present study, we investigated the clinical outcomes of and management strategies for ESD-related perforations. METHODS: Between February 2010 and April 2014, a total of 3821 patients who underwent ESD for an upper gastrointestinal epithelial neoplasm were analyzed using the Yonsei University Severance Hospital database. Clinical outcomes of and management strategies for perforations in 90 patients (2.4 %) were analyzed. The risk factors for the development of perforation were also investigated. RESULTS: The mean age of our subjects was 64.7 ± 12.2 years (male to female ratio, 3.2:1), and the mean size of the resected specimens was 39.4 ± 12.5 mm. Endoscopically visible perforations (visible perforation group) were noted in 74 of the 90 patients (82.2 %), and clinically suspected perforations (suspected perforation group) were noted in 16 patients (17.8 %). Immediate closure with endoclips was attempted in cases with a visible perforation and was successful in 72 (97.3 %) cases. Two patients in whom endoscopic closure failed underwent surgery. Conservative care, including fasting and intravenous antibiotic administration, was attempted in the suspected perforation group, and all the patients were treated successfully without surgery. The mean durations of fasting, antibiotic treatment, and hospital stay were 3.8 ± 3.1, 6.8 ± 4.2, and 8.7 ± 5.3 days, respectively. Subgroup analysis of perforation type (visible perforation vs. suspected perforation) revealed no significant difference in the clinical course. Tumor location at the upper or middle third of the stomach was significantly associated with perforation. CONCLUSION: Most of the ESD-related perforations in upper gastrointestinal epithelial neoplasm could be managed successfully in a non-surgical manner under strict monitoring.
Authors: Y Maeda; D Hirasawa; N Fujita; T Obana; T Sugawara; T Ohira; Y Harada; T Yamagata; K Suzuki; Y Koike; Y Yamamoto; Z Kusaka; Y Noda Journal: Endoscopy Date: 2012-03-09 Impact factor: 10.093
Authors: M Fujishiro; N Yahagi; N Kakushima; S Kodashima; Y Muraki; S Ono; K Kobayashi; T Hashimoto; N Yamamichi; A Tateishi; Y Shimizu; M Oka; K Ogura; T Kawabe; M Ichinose; M Omata Journal: Endoscopy Date: 2006-10 Impact factor: 10.093
Authors: Min Kim; Seong Woo Jeon; Kwang Bum Cho; Kyung Sik Park; Eun Soo Kim; Chang Keun Park; Hyang Eun Seo; Yun Jin Chung; Joong Goo Kwon; Jin Tae Jung; Eun Young Kim; Byeong Ik Jang; Si Hyung Lee; Kyeong Ok Kim; Chang Hun Yang Journal: Surg Endosc Date: 2012-12-13 Impact factor: 4.584