title: Gastric obstruction after endoscopic submucosal dissection.
abstract: BACKGROUND
  Bleeding and perforation are two major complications of gastric endoscopic submucosal dissection (ESD). There are only a few reports concerning gastric obstruction related to ESD in the stomach.
  
  
  OBJECTIVE
  The aim of this study was to clarify the clinicopathological features of patients who experienced gastric obstruction after gastric ESD.
  
  
  METHODS
  Clinicopathological data of 1878 patients who underwent gastric ESD from September 2002 to December 2010 were retrospectively reviewed. Data of lesion location, circumference, circumferential extent of ESD ulcer, specimen diameter, depth of cancer, ulcer findings within the lesion, curability of ESD, number of simultaneous lesions, and occurrence of post-operative bleeding and perforation were collected. The risk of gastric obstruction regarding lesion and procedure related factors were assessed, and treatment for these patients was studied.
  
  
  RESULTS
  Gastric obstruction was observed in 2.5% of the patients (47/1878). Symptoms occurred in a median of 24 days after ESD. The incidence among patients with lesions in the upper part of the stomach was 4.7% (17/316), 0.36% (3/818) in the middle, and 3.8% (27/699) in the lower part. In relation to the circumferential extent, the incidence was 50% (33/66) among patients with a resection of >75% of the circumference. Stenosis was observed in 87% (41/47) of patients with gastric obstruction. Endoscopic balloon dilation was performed in 45 patients. Perforation due to EBD occurred in four patients; one was referred to surgery.
  
  
  CONCLUSIONS
  Patients with a wide resection of >75% of the circumference should be considered for early repeat endoscopy after ESD, and dilation should be performed with caution if found to have stenosis.
authors.affiliation: Shizuoka Cancer Center, Shizuoka, Japan.
authors.forename: Naomi
authors.initials: N
authors.lastname: Kakushima
authors.affiliation: Shizuoka Cancer Center, Shizuoka, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Tanaka
authors.affiliation: Shizuoka Cancer Center, Shizuoka, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Sawai
authors.affiliation: Shizuoka Cancer Center, Shizuoka, Japan.
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Imai
authors.affiliation: Shizuoka Cancer Center, Shizuoka, Japan.
authors.forename: Noboru
authors.initials: N
authors.lastname: Kawata
authors.affiliation: Shizuoka Cancer Center, Shizuoka, Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Hagiwara
authors.affiliation: Shizuoka Cancer Center, Shizuoka, Japan.
authors.forename: Toshitatsu
authors.initials: T
authors.lastname: Takao
authors.affiliation: Shizuoka Cancer Center, Shizuoka, Japan.
authors.forename: Kinichi
authors.initials: K
authors.lastname: Hotta
authors.affiliation: Shizuoka Cancer Center, Shizuoka, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Yamaguchi
authors.affiliation: Shizuoka Cancer Center, Shizuoka, Japan.
authors.forename: Kohei
authors.initials: K
authors.lastname: Takizawa
authors.affiliation: Shizuoka Cancer Center, Shizuoka, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Matsubayashi
authors.affiliation: Shizuoka Cancer Center, Shizuoka, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Ono
keywords: Early gastric cancer; endoscopic balloon dilation (EBD); endoscopic resection; endoscopic submucosal dissection (ESD); stenosis