Clin Endosc.  2015 May;48(3):251-255. 10.5946/ce.2015.48.3.251.

Delayed Perforation Occurring after Endoscopic Submucosal Dissection for Early Gastric Cancer

• Kang SH
• Lee K
• Lee HW
• Park GE
• Hong YS
• Min BH

• KMID: 2148575
• DOI: http://doi.org/10.5946/ce.2015.48.3.251

Abstract

Delayed perforation is a very rare complication of endoscopic submucosal dissection (ESD), with a reported incidence of 0.1% to 0.45%. Few reports exist on the clinical features and outcomes of delayed perforation after ESD, and it is unclear whether the optimal management strategy is emergency surgery or endoscopic closure with conservative treatment. Here, we report two cases of delayed perforation occurring after ESD for early gastric cancer. In both cases, lesions were located in the antrum, and tumor depths were confined to the mucosal layer. Total procedure times for ESD were 25 and 45 minutes, respectively. Because delayed perforation may be associated with excessive thermal damage and necrosis of the muscle layer, treatment with emergency surgery should be used instead of conservative management in cases of delayed perforation after ESD.

Keyword

Coagulation; Endoscopy; Perforation; Stomach neoplasms; Surgery

MeSH Terms

Emergencies
Endoscopy
Incidence
Necrosis
Stomach Neoplasms*

Figure

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  Fig. 1 (A) White light endoscopy image shows a 1.2 cm-sized type IIc early gastric cancer lesion on the anterior wall of the proximal antrum. (B) Appearance of the iatrogenic ulcer after endoscopic submucosal dissection (ESD). (C) Endoscopic view shows a 1 cm-sized gastric wall defect in the ESD-induced ulcer base. (D) Perforation hole is successfully closed with three endoclips.

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  Fig. 2 (A) Chest X-ray taken immediately after the endoscopic submucosal dissection (ESD) procedure reveals no free air. (B) No free air is seen on chest radiography taken 12 hours after the ESD procedure, when the patient first complained of abdominal pain. (C) Follow-up chest radiography at 23 hours after the ESD procedure shows free air.

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  Fig. 3 A 3 cm-sized laceration is found at the previous endoscopic submucosal dissection site, and primary open repair is performed.

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  Fig. 4 (A) White light endoscopy image shows a 1.8 cm-sized early gastric cancer on the lesser curvature of the antrum. (B) Appearance of the iatrogenic ulcer after endoscopic submucosal dissection (ESD). (C) Endoscopic view shows a 2 cm-sized perforation in the ESD-induced ulcer base. (D) Pathologic specimen of the segmental resection shows a 2 cm-sized perforation on the lesser curvature of the antrum.

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