title: Criteria for non-surgical treatment of perforation during colorectal endoscopic submucosal dissection.
abstract: OBJECTIVE
  Endoscopic submucosal dissection (ESD) has recently been applied in the treatment of large colorectal tumors. However, indications for emergent surgery and criteria for conservative treatment of perforation remain unclear. The aim of this study was to clarify the criteria for non-surgical treatment of perforation during colorectal ESD.
  
  
  METHODS
  219 colorectal tumors in 215 patients (136 men and 79 women; median age 69 years) were removed by performing ESD. The procedural outcomes, complications, prognoses, and criteria for non-surgical treatment of perforation were retrospectively analyzed by using our prospectively corrected database.
  
  
  RESULTS
  The en-bloc and complete en-bloc resection rates were 92.7% (203/219) and 85.8% (188/219), respectively. The rate of discontinued ESD was 2.3% (5/219). The immediate and delayed perforation rates were 5.0% (11/219) and 0%, respectively. One of these patients required emergent surgery because of a residual lesion and localized peritonitis caused by an unsuccessful closure. The other 10 patients recovered with conservative treatment after successful closure with hemoclips and complete resection. The defects in all patients were successfully closed by using hemoclips. None of the patients had signs of diffuse peritonitis. The other factors, i.e. absence of localized peritonitis, high-grade fever, and acceleration of inflammatory reaction, were not associated with the success or the failure of the non-surgical treatment.
  
  
  CONCLUSIONS
  The criteria for non-surgical treatment of perforation caused by colonic ESD were absence of diffuse peritonitis and successful closure.
authors.affiliation: Department of Gastroenterology, Saku Central Hospital, Saku, Japan. k.hotta@scchr.jp
authors.forename: Kinichi
authors.initials: K
authors.lastname: Hotta
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Shinohara
authors.forename: Tsuneo
authors.initials: T
authors.lastname: Oyama
authors.forename: Eiji
authors.initials: E
authors.lastname: Ishii
authors.forename: Akihisa
authors.initials: A
authors.lastname: Tomori
authors.forename: Akiko
authors.initials: A
authors.lastname: Takahashi
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Miyata
mesh_terms: D003113:Colonoscopy / Q000009:adverse effects*; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D004210:Dissection / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology / Q000601:surgery*; D007431:Intraoperative Complications; D008297:Male; D012189:Retrospective Studies