Clin Endosc.  2014 Sep;47(5):398-403. 10.5946/ce.2014.47.5.398.

Complications Related to Gastric Endoscopic Submucosal Dissection and Their Managements

• Saito I
• Tsuji Y
• Sakaguchi
• Niimi K
• Ono S
• Kodashima
• Yamamichi
• Fujishiro
• Koike K

• KMID: 2165369
• DOI: http://doi.org/10.5946/ce.2014.47.5.398

Abstract

Endoscopic submucosal dissection (ESD) for early gastric cancer is a well-established procedure with the advantage of resection in an en bloc fashion, regardless of the size, shape, coexisting ulcer, and location of the lesion. However, gastric ESD is a more difficult and meticulous technique, and also requires a longer procedure time, than conventional endoscopic mucosal resection. These factors naturally increase the risk of various complications. The two most common complications accompanying gastric ESD are bleeding and perforation. These complications are known to occur both intraoperatively and postoperatively. However, there are other rare but serious complications related to gastric ESD, including aspiration pneumonia, stenosis, venous thromboembolism, and air embolism. Endoscopists should have sufficient knowledge about such complications and be prepared to deal with them appropriately, as successful management of complications is necessary for the successful completion of the entire ESD procedure.

Keyword

Endoscopic submucosal dissection; Complication; Hemorrhage; Perforation

MeSH Terms

Constriction, Pathologic
Embolism, Air
Hemorrhage
Pneumonia, Aspiration
Stomach Neoplasms
Ulcer
Venous Thromboembolism

Figure

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  Fig. 1 A case of postoperative bleeding. (A) An example of postoperative (day 1 after endoscopic submucosal dissection) bleeding with a large amount of hematoma. (B) Pulsating bleeding observed after the hematoma has been removed. (C) Successful hemostasis by using endoclips.

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  Fig. 2 Intra-abdominal free air detected on plain radiograph after gastric endoscopic submucosal dissection (ESD). Free air (arrows) was observed on the surface of the liver after gastric ESD, on plain radiograph in the left lateral decubitus position.

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  Fig. 3 A case of intraoperative perforation. (A) A small perforation occurring during gastric endoscopic submucosal dissection. (B) The perforation site closed successfully by using endoclips.

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