Clinical outcomes for patients with perforations during endoscopic submucosal dissection of laterally spreading tumors of the colorectum
Surgical Endoscopy, 08/01/2012
Yoon JY et al. – The clinical complications for microperforation patients were worse than those for macroperforation patients. However, the clinical prognoses of patients with perforations that occur during colonic ESD are favorable.Methods
- This study enrolled 101 patients with colorectal laterally spreading tumors (LST) who underwent ESD.
- They retrospectively reviewed their medical records, including patient demographic data and the clinical, endoscopic, and pathologic features.
- In the cases where perforation had occurred, the course of hospital treatment was analyzed.
- All ESD–related perforations were divided into macroperforations and microperforations.
- A macroperforation was defined as a gross perforation that occurred during an ESD procedure and a microperforation was defined by free air visible on X–rays after the procedure.
- Of the 101 enrolled patients, 9 (8.9 %) developed perforations.
- The most common tumor morphology was nongranular–type LST (5 of 9 cases, 55.6 %) based on endoscopic examination.
- Five patients had microperforations and four had macroperforations.
- All macroperforations were closed primarily by endoclips during ESD.
- The endoscopic characteristics did not differ between the groups.
- However, the length of hospital stay and the mean duration of NPO and antibiotic treatments were longer for microperforation patients.
- All patients had conservative nonsurgical management such as fasting, intravenous antibiotics, and nasogastric tube drainage.