Management of complications following endoscopic submucosal dissection for gastric cancer

Abstract

Endoscopic treatment should be considered for early gas tric cancer (EGC) and gastric precancerous lesions. Endo scopic submucosal dissection (ESD) was developed for en bloc removal of a large gastric neoplasm and has been developed following improvements in electrical equip ment for hemostasis and dissection and with advances in various knives, hemostatic forceps and endoscopic equipment. ESD is currently the treatment of choice for precancerous lesions or EGC showing mucosal invasion. Hemorrhage and perforation are major complications of ESD for EGC. We describe the complication of ESD pro cedures in gastric lesions for endoscopists who are rela tively inexperienced in ESD and who may lack optimal access to ESD education and facilities.

Process of technical stabilization of gastric endoscopic submucosal dissection at the National Cancer Center in Japan

“…In the present study, one patient underwent emergency surgery due to intraoperative bleeding in the early period of gastric ESD, but the remaining patients with complications were successfully managed endoscopically without any need for surgical intervention, consistent with previous reports (20,21). However, in cases with bleeding occurring in spurts, there is a risk of the development of cardiopulmonary instability.…”

“…After a lapse of 10 years, endoscopic devices and related medical equipment have been developed with further refinements in the procedural techniques, which have led to a higher rate of resectability and lower rate of complications, as well as technical stabilization of gastric ESD. In particular, control of intraoperative bleeding is critical to a successful outcome of ESD; therefore, it has been estimated that improving the management of intraoperative bleeding by various advances in endoscopic devices and medical equipment, together with procedural refinements has enabled complete and safe resection (20,21). Furthermore, post-ESD preventive coagulation of visible vessels in the resection area of ESD, which was introduced in 2003, may have resulted in the lower rate of delayed bleeding observed in the last period (16).…”

Human hybrid endoscopic and laparoscopic management of mass lesions of the foregut (with video)

“…A bleeding rate of 5% to 10% and a perforation rate of 2% to 10% have been reported with ESD. 21,22 Perforation closure with endoscopic clips is not ideal if it can be avoided. Many of the ceramic tip needle-knives and hook-tip needle-knives used in ESD are not available in the United States.…”

Disección submucosa endoscópica, ¿solo para endoscopistas expertos?

“…En caso de hemorragia durante el procedimiento de disección, se ha recomendado el uso de electrocoagulación o coagulación con gas argón, mientras que los clips metálicos se deberían usar solo en casos de hemorragia no controlable por los métodos anteriores ya que tienen el inconveniente de ocultar el campo visual del endoscopista y pueden dificultar las maniobras con los bisturíes endoscópicos. Para evitar la hemorragia, se puede efectuar una coagulación previa a la disección de la submucosa o usar una pinza de hemostasia para coagular los vasos de grueso calibre 62,63 . Se han descrito varios factores asociados a un mayor riesgo de hemorragia.…”