Complications Related to Gastric Endoscopic Submucosal Dissection and Their Managements

Saito, Itaru; Tsuji, Yosuke; Sakaguchi, Yoshiki; Niimi, Keiko; Ono, Satoshi; Kodashima, Shinya; Yamamichi, Nobutake; Fujishiro, Mitsuhiro; Koike, Kazuhiko

doi:10.5946/ce.2014.47.5.398

Cited by 81 publications

(52 citation statements)

References 29 publications

(62 reference statements)

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“…If bleeding cannot be well controlled under endoscopy, we should switch to surgical treatment or arterial embolism without hesitation. In addition, patients with massive bleeding are advised to continue intravenous infusion of large doses of PPIs to maintain a gastric pH of above 6, so as to facilitate thrombocyte aggregation, avert thrombolysis, cease hemorrhage and prevent rebleeding …”

Section: Treatment Of Bleeding After Gastric Esdmentioning

confidence: 99%

Bleeding after endoscopic submucosal dissection of gastric lesions

Yang

Qiu

et al. 2020

J of Digest Diseases

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Endoscopic submucosal dissection (ESD) is generally used to treat gastric mucosal and submucosal lesions. Nevertheless, ESD is more difficult and complicated to perform than a traditional endoscopic mucosal resection, which can increase the incidence of various complications including hemorrhage, perforation and infection. Hemorrhage is a major post‐ESD complication. Prevention and early diagnosis of post‐ESD bleeding for gastric lesions are closely associated with the efficacy and safety of the operation. Many studies have reported the risks of and the preventative measures for hemorrhage after gastric ESD, but there remain some issues to be solved. We thus reviewed the risk factors, precautions and treatments for hemorrhage after ESD of gastric lesions.

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Section: Treatment Of Bleeding After Gastric Esdmentioning

confidence: 99%

Bleeding after endoscopic submucosal dissection of gastric lesions

Yang

Qiu

et al. 2020

J of Digest Diseases

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“…However, there are no clinical studies to support this theory. Association studies between risk of intraprocedural bleeding and the depth of submucosal dissection would be difficult to conduct, primarily because of the clinical variability among patients, other risk factors (hypertension, coagulopathy, cirrhosis, diabetes, anticoagulant use), and factors intrinsic to the lesion (size, location, submucosal invasion, and recurrence) (4,46,47) . These confounding factors are eliminated using experimental animals.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of Gastric Submucosal Dissection Depth to Evaluate Skill Acquirement in Short Term Training Courses in Esd: An Experimental Study

Yamazaki

Moura

Veras

et al. 2018

Arq. Gastroenterol.

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BACKGROUND: Endoscopic submucosal dissection (ESD) is a complex endoscopic procedure, with high rates of adverse events and technical difficulties. To overcome that problem, many training centers published the importance of animal models for skill acquirement in ESD. However, no study has used the submucosal dissection depth (DSUB) as a parameter to evaluate the learning curve in ESD, which might be a relevant factor since an optimal resection plane is important to achieve a curative resection and avoid intraoperative complications. OBJECTIVE: This study aimed to assess ESD skill acquirement after short-term training sessions by evaluating the submucosal dissection depth (DSUB) and the association with adverse events. METHODS: This experimental study included 25 experienced endoscopists in therapeuthic procedures (>5years) and 75 specimens resected by ESD (three resections / endoscopist). Learning parameters (resection time, size, en bloc resection rate, bleeding, perforation and submucosal dissection depth) were prospectively evaluated. The percentages of DSUB of all specimens resected were calculated. RESULTS: All specimens were resected from the gastric body (n=75). The mean size of the resected specimens was 23.97±7.2 mm. The number of adverse events, including bleeding, perforation, and death, were 17 (22.67%), 3 (4%), and 0 cases, respectively. The average mean time by the third dissection decreased from 28.44±9.73 to 18.72±8.81 min (P<0.001). The proportion of DSUB in the bleeding and non-bleeding group were respectively 37.97%±21.13% and 68.66%±23.99%, indicating a significant association between DSUB and bleeding incidence (P<0.001). The ROC curve analysis indicated a cut-off point of 61% (sensitivity, 64%; specificity, 94%) of submucosal dissection depth associated with bleeding. Therefore, when ESD was performed at a depth of >61% of the submucosal layer, the risk for bleeding during the procedure decreased (PPV, 0.97; 95% CI, 0.85-0.99). CONCLUSION: Improvement in the learning curve in ESD and a better cognitive ability were seen by the third dissection in these short term training courses. And a significant association between DSUB and the risk of bleeding.

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“…Similarly, we showed that an oral extension of the buried mucosa of 0.5–7.5 mm was observed in 64.3% of patients with Barrett's adenocarcinoma. In practical settings, endoscopic treatment extending more than 1 cm proximal to the endoscopic SCJ is recommended, but larger‐sized resection can cause other complications, such as bleeding and stenosis . Accordingly, the clinical significance of preoperative detection of Barrett's mucosa buried underneath endoscopically normal epithelium has increased, although it is difficult for clinically available endoscopic modalities to detect them accurately.…”

Section: Discussionmentioning

confidence: 99%