Nonsurgical Treatment of Gastric Perforation Complicated by Endoscopic Mucosal Resection and Endoscopic Submucosal Dissection.
- Author:
Seok Guen LEE
1
;
Kwang Bum CHO
;
Yoon Suk HONG
;
Hyun Woong LEE
;
Jung Min LEE
;
Byoung Kuk JANG
;
Woo Jin CHUNG
;
Kyung Sik PARK
;
Jae Seok HWANG
;
Eun Jee PARK
Author Information
1. Department of Internal Medicine, Keimyung University College of Medicine, Daegu, Korea. chokb@dsmc.or.kr
- Publication Type:Original Article
- Keywords:
Perforation;
Conservative management;
Endoscopic submucosal dissection
- MeSH:
Adenoma;
Anti-Bacterial Agents;
Hemorrhage;
Humans;
Resuscitation;
Stomach;
Stomach Neoplasms
- From:Korean Journal of Gastrointestinal Endoscopy
2008;37(2):97-104
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND/AIMS: Endoscopic Mucosal Resection (EMR) and Endoscopic Submucosal Dissection (ESD) are novel techniques used for the treatment of early gastric cancer and precancerous lesions of the stomach. However, complications such as bleeding and perforation may occur during the procedure, and these complications may raise the morbidity and mortality rates. EMR/ESD-induced perforations can be treated with conservative medical or non-surgical methods. Furthermore, an increasing number of reports have addressed conservative management of EMR/ESD-induced perforations. We evaluated the effectiveness and safety of implementing conservative treatment for perforations associated with EMR and ESD. METHODS: We reviewed 482 patients with 507 lesions who underwent EMR or ESD due to early gastric cancers or gastric adenomas between February 2003 and December 2007. We identified 14 perforations occurring as complications of EMR/ESD and investigated their clinical outcomes. RESULTS: Fourteen perforations (14/507 [2.8%]) occurred, 11 of which were immediately clipped during the procedure, and 3 of which were diagnosed after the procedure when free air was visualized on the radiograph. All patients were managed conservatively with fluid resuscitation and antibiotics (mean, 5.8 days). They recovered without surgery and were discharged in stable condition at a mean of 7.2 days post-procedure. CONCLUSIONS: Endoscopic clip application might be an effective and safe option for conservative management of EMR/ESD-induced perforations.
