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Review
. 2011 Aug 21;17(31):3575-9.
doi: 10.3748/wjg.v17.i31.3575.

Management of the complications of endoscopic submucosal dissection

Seong Hwan Kim  1 , Jeong Seop Moon, Young Hoon Youn, Ki Myung Lee, Sung Joon Lee
Affiliations
Review

Management of the complications of endoscopic submucosal dissection

Seong Hwan Kim et al. World J Gastroenterol. .

Abstract

Endoscopic submucosal dissection (ESD) is currently widely accepted as a standard treatment option for early gastrointestinal neoplasms in Korea. However, ESD has technical difficulties and a longer procedure time than conventional endoscopic resection. So it may have a higher risk of complications than conventional endoscopic resection techniques. We, the ESD study group of Korean Society of Gastrointestinal Endoscopy, have experienced many complications, mostly treated by endoscopic or conservative management. Here, we introduce and share our experiences for management of post ESD complications and review published papers on the topic.

Keywords: Complication; Endoscopic submucosal dissection; Management.

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Figures

Figure 1
Figure 1
Endoscopic views. A: Endoscopic view of exposed vessels on post endoscopic submucosal dissection (ESD) ulcer, showing hemoclipping for prevention of delayed bleeding; B, C: Endoscopic view of oozing of blood during ESD, showing immediate electrocoagulation by IT knife itself; D, E: Endoscopic view of pulsatile bleeding during ESD (D) and showing coagulation by hemostatic forcep (E); F: Endoscopic view shows that microvessels of the submucosal layer are cauterized by flex knife; G-I: Endoscopic view of jejunal loop side of G-Jstomy showing a perforation (arrow) seen during ESD for EGC of stoma of remnant stomach (G), and the view after closure of the perforation by endoclips (H). A follow-up endoscopy showed the healed perforation 2 wk after endoscopic closure (I); J-L: Endoscopic view shows severe antral stenosis 7 wk after gastric ESD (J). Endoscopic view of balloon dilation procedure (K). A follow-up endoscopic view showed relieved stenosis without any symptoms 3 mo after balloon dilatation (L). Ulcer induced stricture was detected at 4 wk after ESD.
Figure 2
Figure 2
Abdominal radiograph showed pneumoperitoneum.
See this image and copyright information in PMC

References

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    1. Kim SG. Endoscopic manipulation of complications. Korean J Gastrointest Endosc. 2007;35 Suppl 1:S65–S69.
    1. Kim JJ. The management of the complications in the endoscopic mucosal resection-prevention and treatment. Korean J Gastrointest Endosc. 2006;32 Suppl 1:S125–S129.
    1. Toyonaga T. ESD atlas-selection of devices and capture method according to the region. 1st ed. Seoul: Hankuk; 2007.
    1. Saito Y, Uraoka T, Matsuda T, Emura F, Ikehara H, Mashimo Y, Kikuchi T, Fu KI, Sano Y, Saito D. Endoscopic treatment of large superficial colorectal tumors: a case series of 200 endoscopic submucosal dissections (with video) Gastrointest Endosc. 2007;66:966–973. - PubMed

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