Endoscopic closure of perforations caused by EMR in the stomach by application of metallic clips

Tsunada, Seiji; Ogata, Shinichi; Ohyama, Takashi; Ootani, Hibiki; Oda, Kayoko; Kikkawa, Atsushi; Ootani, Akifumi; Sakata, Hiroyuki; Iwakiri, Ryuichi; Fujimoto, Kazuma

doi:10.1016/s0016-5107(03)70051-0

Cited by 99 publications

(62 citation statements)

References 13 publications

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“…Several reports have demonstrated risk factors for postoperative bleeding after conventional EMR for early gastric cancers [18,19,20], but a few case series have focused on complications associated with ESD, such as postoperative bleeding and perforation [12,19,20]. Several recent reports, including our previous study, have indicated risk factors for these complications (perforation and postoperative bleeding) of ESD [11,21].…”

Section: Introductionmentioning

confidence: 85%

“…Despite these advantages, ESD requires specialized skills and has a high frequency of complications, particularly perforation and delayed postoperative bleeding [8,11,12,13,14,15,16,17]. Several reports have demonstrated risk factors for postoperative bleeding after conventional EMR for early gastric cancers [18,19,20], but a few case series have focused on complications associated with ESD, such as postoperative bleeding and perforation [12,19,20].…”

Section: Introductionmentioning

confidence: 99%

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Perforation and Postoperative Bleeding of Endoscopic Submucosal Dissection in Gastric Tumors: Analysis of 1,190 Lesions in Low- and High-Volume Centers in Saga, Japan

et al. 2012

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Background: This retrospective study aimed to determine risk factors associated with serious complications of endoscopic submucosal dissection of gastric tumors in multicenters compared between high- and low-volume centers. Methods: Between 2001 and 2010, gastric endoscopic submucosal dissection was performed in 1,190 lesions of 1,082 patients in five hospitals in Saga, three high-volume and two low-volume centers. Risk factors for serious complications were evaluated. Patients’ background characteristics were evaluated, including anticoagulants use and underlying diseases. Results: Postoperative bleeding was detected in 75 patients (6.9%), and perforation was detected in 40 patients (3.7%). Most postoperative bleeding and perforation cases were recovered with endoscopic procedures, although one case of each complication was treated by emergency surgery. Multivariate analysis indicated that risk factors for perforation were tumor location, massive submucusal invasion, endoscopists’ experience of 100–149 cases and hypertension, and that risk factors for postoperative bleeding were tumor location, resected tumor size, and scar lesion. The serious complications were not different between high- and low-volume centers. Conclusions: The present study indicated that risk factors for perforation during endoscopic submucosal dissection were tumor, endoscopist and patient related, although risk factors for postoperative bleeding were tumor related. There was no difference in complications between high- and low-volume centers.

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Section: Introductionmentioning

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Perforation and Postoperative Bleeding of Endoscopic Submucosal Dissection in Gastric Tumors: Analysis of 1,190 Lesions in Low- and High-Volume Centers in Saga, Japan

et al. 2012

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“…These perforations are typically closed with the aid of endoclips, as previously described (Fig. 8C,D) [68,69], because the stomach in patients during gastric EMR or ESD is thought to be comparatively clean due to their fasting before undergoing these procedures, and because of the antibacterial effect of gastric acid.…”

Section: Endoscopic Submucosal Dissection (Esd)mentioning

confidence: 99%

Endoscopic resection of early gastric cancer

2007

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The purpose of this review is to examine recent advances in the techniques and technologies of endoscopic resection of early gastric cancer (EGC). Endoscopic mucosal resection (EMR) of EGC, with negligible risk of lymph node metastasis, is a standard technique in Japan and is increasingly becoming accepted and regularly used in Western countries. EMR is a minimally invasive technique which is safe, convenient, and effi cacious; however, it is insuffi cient when treating larger lesions. The evidence suggests that diffi culties with the correct assessment of depth of tumor invasion lead to an increase in local recurrence with standard EMR when lesions are larger than 15 mm. A major factor contributing to this increase in local recurrence relates to lesions being excised piecemeal due to the technical limitations of standard EMR. A new development in endoscopic techniques is to dissect directly along the submucosal layer -a procedure called endoscopic submucosal dissection (ESD). This allows the en-bloc resection of larger lesions. ESD is not necessarily limited by lesion size and it is predicted to replace conventional surgery in dealing with certain stages of ECG. However, it still has a higher complication rate when compared to standard EMR, and it requires high levels of endoscopic skill and experience. Endoscopic techniques, indications, pathological assessment, and methods of endoscopic resection of EGC need to be established for carrying out appropriate treatment and for the collation of long-term outcome data.

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“…Mehrere Studien der letzten Jahre aus großen Zentren konnten zeigen, dass der überwiegende Anteil interventionell bedingter Perforationen durch endoskopische Methoden konservativ behandelt werden kann. Die Ergebnisse scheinen nicht schlechter zu sein als bei einem primär chirurgischen Vorgehen zur Behandlung der Komplikation [19][20][21][22][23]. Insbesondere kleinere Perforationen im oberen Gastrointestinaltrakt mit geringer Kontamination des Bauchraums,bei denen ein , kompletter Verschluss der Läsion endoskopisch möglich ist, können zunächst konservativ behandelt werden [24].…”

Section: Perforationunclassified

Endoskopische Komplikationen und endoskopisches Komplikationsmanagement an Kardia und Magen

Kraft¹,

Mayerle²,

Simon³

et al. 2008

Chir Gastroenterol

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Durch innovative Techniken getragen hat sich die interventionelle Endoskopie in den letzten Jahren immer mehr den chirurgischen Therapieverfahren angenähert. Der endoskopischen Intervention scheinen dabei Organgrenzen nicht mehr im Wege zu stehen. Dieser Fortschritt wird indes durch eine Zunahme von Komplikationen erkauft. Ziel der vorliegenden Übersicht ist es, die wesentlichen Komplikationen endoskopischer Interventionen an Magen und Kardia aufzuzeigen und deren endoskopische Therapiemöglichkeiten darzustellen.

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Endoscopic closure of perforations caused by EMR in the stomach by application of metallic clips

Cited by 99 publications

References 13 publications

Perforation and Postoperative Bleeding of Endoscopic Submucosal Dissection in Gastric Tumors: Analysis of 1,190 Lesions in Low- and High-Volume Centers in Saga, Japan

Perforation and Postoperative Bleeding of Endoscopic Submucosal Dissection in Gastric Tumors: Analysis of 1,190 Lesions in Low- and High-Volume Centers in Saga, Japan

Endoscopic resection of early gastric cancer

Endoskopische Komplikationen und endoskopisches Komplikationsmanagement an Kardia und Magen

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