Clinical outcomes for patients with perforations during endoscopic submucosal dissection of laterally spreading tumors of the colorectum.
BACKGROUND
Endoscopic submucosal dissection (ESD) for colorectal neoplasms is not widely performed because of the high risk of perforation. Perforations are divided into macroperforations and microperforations. Currently, there is a limited amount of clinical data on the outcome of patients with these types of perforations during colonic ESD. The aim of this study was to investigate the clinical outcome of patients who sustained colon perforations during ESD. We also compared the clinical outcome of patients with microperforations and those with macroperforations.


METHODS
This study enrolled 101 patients with colorectal laterally spreading tumors (LST) who underwent ESD. We retrospectively reviewed their medical records, including patient demographic data and the clinical, endoscopic, and pathologic features. In the cases where perforation had occurred, the course of hospital treatment was analyzed. All ESD-related perforations were divided into macroperforations and microperforations. A macroperforation was defined as a gross perforation that occurred during an ESD procedure and a microperforation was defined by free air visible on X-rays after the procedure.


RESULTS
Of the 101 enrolled patients, 9 (8.9 %) developed perforations. The most common tumor morphology was nongranular-type LST (5 of 9 cases, 55.6 %) based on endoscopic examination. Five patients had microperforations and four had macroperforations. All macroperforations were closed primarily by endoclips during ESD. The endoscopic characteristics did not differ between the groups. However, the length of hospital stay and the mean duration of NPO and antibiotic treatments were longer for microperforation patients. All patients had conservative nonsurgical management such as fasting, intravenous antibiotics, and nasogastric tube drainage.


CONCLUSIONS
The clinical complications for microperforation patients were worse than those for macroperforation patients. However, the clinical prognoses of patients with perforations that occur during colonic ESD are favorable.
Department of Internal Medicine, Digestive Disease Center, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-ro Hwayang-dong, Gwangjin-gu, Seoul 143-729, Korea.
Jung Yoon
JY
Yoon
Jeong Hwan
JH
Kim
Ji Young
JY
Lee
Sung Noh
SN
Hong
Sun-Young
SY
Lee
In-Kyung
IK
Sung
Hyung Seok
HS
Park
Chan Sup
CS
Shim
Hye Seung
HS
Han
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003106:Colon / Q000293:injuries*; D003113:Colonoscopy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa; D007416:Intestinal Perforation / Q000209:etiology*; D007431:Intraoperative Complications / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D012189:Retrospective Studies; D016896:Treatment Outcome