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. 2012 Jan 16;4(1):1-8.
doi: 10.4253/wjge.v4.i1.1.

Management of bleeding and artificial gastric ulcers associated with endoscopic submucosal dissection

Yosuke Muraki  1 , Shotaro Enomoto, Mikitaka Iguchi, Mitsuhiro Fujishiro, Naohisa Yahagi, Masao Ichinose
Affiliations

Management of bleeding and artificial gastric ulcers associated with endoscopic submucosal dissection

Yosuke Muraki et al. World J Gastrointest Endosc. .

Abstract

Endoscopic submucosal dissection (ESD), an endoscopic procedure for the treatment of gastric epithelial neoplasia without lymph node metastases, spread rapidly, primarily in Japan, starting in the late 1990s. ESD enables en bloc resection of lesions that are difficult to resect using conventional endoscopic mucosal resection (EMR). However, in comparison to EMR, ESD requires a high level of endoscopic competence and a longer resection time. Thus, ESD is associated with a higher risk of adverse events, including intraoperative and postoperative bleeding and gastrointestinal perforation. In particular, because of a higher incidence of intraoperative bleeding with mucosal incision and submucosal dissection, which are distinctive endoscopic procedures in ESD, a strategy for endoscopic hemostasis, mainly by thermo-coagulation hemostasis using hemostatic forceps, is important. In addition, because of iatrogenic artificial ulcers that always form after ESD, endoscopic hemostasis and appropriate pharmacotherapy during the healing process are essential.

Keywords: Artificial ulcer; Endoscopic hemostasis; Endoscopic submucosal dissection; Gastric epithelial neoplasia; Hemostatic forceps.

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Figures

Figure 1
Figure 1
Hemostatic forceps tips. A: Monopolar hemostatic forceps (HDB2422W; Pentax, Tokyo, Japan); B: Bipolar hemostaticforceps (H-S2518; Pentax, Tokyo, Japan); C: Hemostatic forceps (Coagrasper: FD-410LR; Olympus, Tokyo, Japan); D: Hot biopsy forceps (FD-1L-1; Olympus, Tokyo, Japan).
Figure 2
Figure 2
Hemostatic procedure for endoscopic submucosal dissectionintraoperative bleeding using hemostatic forceps. A: Pulsatile bleeding is observed during submucosal dissection; B: By filling the tip attachment with water, the bleeding point can be pinpointed and identified; C: After identifying the bleeding point, the vessel is securely grasped by hemostatic forceps, and thermo-coagulation is performed; D: Complete hemostasis is achieved, without excessive coagulation.
See this image and copyright information in PMC

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