Clinical outcomes for perforations during endoscopic submucosal dissection in patients with gastric lesions.
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.
Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, South Korea. sw-jeon@hanmail.net
Seong Woo
SW
Jeon
Min Kyu
MK
Jung
Sung Kook
SK
Kim
Kwang Bum
KB
Cho
Kyung Sik
KS
Park
Chang Keun
CK
Park
Joong Goo
JG
Kwon
Jin Tae
JT
Jung
Eun Young
EY
Kim
Tae Nyeun
TN
Kim
Byung Ik
BI
Jang
Chang Hun
CH
Yang
D000368:Aged; D016009:Chi-Square Distribution; D005260:Female; D005753:Gastric Mucosa / Q000601:surgery; D005773:Gastroscopy / Q000009:adverse effects*; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D011230:Precancerous Conditions / Q000601:surgery; D011379:Prognosis; D013270:Stomach / Q000293:injuries*; D013274:Stomach Neoplasms / Q000601:surgery*; D016896:Treatment Outcome