Deep mural injury and perforation after colonic endoscopic mucosal resection: a new classification and analysis of risk factors

Burgess, Nicholas G.; Bassan, Milan S.; McLeod, Duncan; Williams, Stephen J.; Byth, Karen; Bourke, Michael J.

doi:10.1136/gutjnl-2015-309848

Cited by 149 publications

(128 citation statements)

References 16 publications

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“…First, although endoscopic and clinical data were consequently collected, the analysis was retrospective in nature. Previous report mentioned that the status of mu- cosal defect after EMR was associated with perforation [30]. However, the detail of mucosal defect after ESD in this study such as submucosal residue and exposed or injured muscle layer was not recorded.…”

Section: Discussionmentioning

confidence: 41%

Differences in Clinical Course of Intraprocedural and Delayed Perforation Caused by Endoscopic Submucosal Dissection for Colorectal Neoplasms: A Retrospective Study

Iwatsubo

Takeuchi

Yamasaki

et al. 2018

Dig Dis

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Background: Although the use of endoscopic submucosal dissection (ESD) as a minimally invasive treatment for large superficial colorectal neoplasms is increasing, colorectal ESD remains technically challenging. As perforation in the colorectum is generally considered to be associated with a higher risk of complications, the aim of this study was to investigate the characteristics of perforation caused by colorectal ESD. Methods: This retrospective study included 635 lesions treated with colorectal ESD, between February 2011 and December 2015, in a tertiary cancer center. We evaluated and compared the clinical course and short-term outcomes of the intraprocedural perforation group with those of the delayed perforation and no perforation groups. Results: Perforation occurred in 45 (7.1%) of the 635 cases. Thirty-six cases were intraprocedural perforation (5.7%), all of which were successfully closed with endoclips during the procedure. Nine cases of delayed perforation occurred (1.4%). No emergency surgery was performed in the intraprocedural perforation group; however, 5 of 9 cases underwent emergency surgery in the delayed perforation group (56%, p < 0.0001). There were statistically significant differences between the intraprocedural and delayed perforation groups with regard to the hospitalization period, fasting period, abdominal pain scale, peak white blood cell (WBC) count, and peak C-reactive protein (CRP), and between the intraprocedural and no perforation groups with regard to the location of the lesion, hospitalization period, fasting period, abdominal pain scale, peak WBC, peak CRP, and en bloc resection rate. Conclusions: While intraprocedural perforation due to colorectal ESD can be managed conservatively, delayed perforation can lead to serious adverse events.

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Section: Discussionmentioning

confidence: 41%

Differences in Clinical Course of Intraprocedural and Delayed Perforation Caused by Endoscopic Submucosal Dissection for Colorectal Neoplasms: A Retrospective Study

Iwatsubo

Takeuchi

Yamasaki

et al. 2018

Dig Dis

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“…As the indications for endoscopy increase, particularly in relation to therapeutic procedures, clinicians will have to deal with an increasing number of complications. Early diagnosis and interventions are important for management of complications related to endoscopy, and treatment sometimes requires a multidisciplinary approach . Complications vary from simple abdominal pain to more serious complications such as bleeding and perforation .…”

Section: Resultsmentioning

confidence: 99%

“…Early diagnosis and interventions are important for management of complications related to endoscopy, and treatment sometimes requires a multidisciplinary approach. 86 Complications vary from simple abdominal pain to more serious complications such as bleeding and perforation. [87][88][89] There are legal implications to these events, which may be unfavorable for physicians even if there is no clear correlation between the medical action and a worsening health condition.…”

Section: Statement 5: Colonoscopy Findings Should Be Well Documentedmentioning

confidence: 99%

Standards of diagnostic colonoscopy for early‐stage neoplasia: Recommendations by an Asian private group

Sano¹,

Chiu

et al. 2019

Digestive Endoscopy

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Background and AimIn recent years, the incidence of colorectal cancer has been increasing, and it is now becoming the major cause of cancer death in Asian countries. The aim of the present study was to develop Asian expert‐based consensus to standardize the preparation, detection and characterization for the diagnosis of early‐stage colorectal neoplasia.MethodsA professional group was formed by 36 experts of the Asian Novel Bio‐Imaging and Intervention Group (ANBI2G) members. Representatives from 12 Asia–Pacific countries participated in the meeting. The group organized three consensus meetings focusing on diagnostic endoscopy for gastrointestinal neoplasia. The Delphi method was used to develop the consensus statements.ResultsThrough the three consensus meetings with debating, reviewing the literature and regional data, a consensus was reached at third meeting in 2016. The consensus was reached on a total of 10 statements. Summary of statements is as follows: (i) Adequate bowel preparation for high‐quality colonoscopy; (ii) Antispasmodic agents for lesion detection; (iii) Image‐enhanced endoscopy (IEE) for polyp detection; (iv) Adenoma detection rate for quality indicators; (v) Good documentation of colonoscopy findings; (vi) Complication rates; (vii) Cecal intubation rate; (viii) Cap‐assisted colonoscopy (CAC) for polyp detection; (ix) Macroscopic classification using indigocarmine spray for characterization of colorectal lesions; and (x) IEE and/or magnifying endoscopy for prediction of histology.ConclusionThis consensus provides guidance for carrying out endoscopic diagnosis and characterization for early‐stage colorectal neoplasia based on the evidence. This will enhance the quality of endoscopic diagnosis and improve detection of early‐stage colorectal neoplasia.

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“…H emostatic clips are established as effective to control active colonic bleeding, 1 to prevent delayed perforation after endoscopic mucosal resection (EMR)-induced deep mural injury, 2 and to close free perforations occurring during EMR 3 and endoscopic submucosal dissection. 4 A common use of clips has been prophylactic closure of colorectal polypectomy sites, with intent to prevent delayed hemorrhage.…”

mentioning

confidence: 99%

Prophylactic Clip Closure Clarified: The Question Is Not Whether to Clip, But When

Rex

2019

Gastroenterology

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Deep mural injury and perforation after colonic endoscopic mucosal resection: a new classification and analysis of risk factors

Abstract: NCT01368289; results.

Cited by 149 publications

References 16 publications

Differences in Clinical Course of Intraprocedural and Delayed Perforation Caused by Endoscopic Submucosal Dissection for Colorectal Neoplasms: A Retrospective Study

Differences in Clinical Course of Intraprocedural and Delayed Perforation Caused by Endoscopic Submucosal Dissection for Colorectal Neoplasms: A Retrospective Study

Standards of diagnostic colonoscopy for early‐stage neoplasia: Recommendations by an Asian private group

Prophylactic Clip Closure Clarified: The Question Is Not Whether to Clip, But When

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