Background and Aims
Despite advances in endoscopic submucosal dissection (ESD), perforation can still
occur. The purpose of this study is to determine the clinical course and effectiveness
of endoscopic closure in addition to the clinicopathologic features related to perforation.
Methods
A total of 935 lesions in 900 consecutive patients between February 1998 and February
2013 underwent ESD for colorectal tumors at our institution. We studied the clinical
course and histologic features of perforation through a matched case-control study
that included 24 patients with intraprocedural perforation and 240 matched patients
without perforation as a control group. Endoscopic closure by using through-the-scope
endoclips was attempted in all cases of intraprocedural perforations immediately after
perforation was recognized during the procedure.
Results
Perforation occurred in 25 cases (2.7%), including 24 intraprocedural perforation
and 1 delayed perforation. All but 1 patient with intraprocedural perforation was
conservatively managed by endoscopic closure. One patient with unsuccessful endoscopic
closure required emergency surgery. Analysis of clinical courses revealed statistically
significant differences (P < .01) between the patients with perforation and the case-controlled, nonperforation
patients in total procedure time, white blood cell count, and level of serum C-reactive
protein on the day after the procedure, admission period, and fasting period. Both
location (P = .027) and submucosal fibrosis (P = .04) of the lesion were significantly associated with perforation. Multivariate
analysis revealed that fibrosis was a significant risk factor associated with perforation
(odds ratio 2.86; 95% confidence interval, 1.03-7.90).
Conclusions
Endoscopic closure allows effective nonsurgical management in cases of intraprocedural
perforation during ESD.
Abbreviations:
CO2 (carbon dioxide), ESD (endoscopic submucosal dissection), LACS (laparoscopy-assisted colorectal surgery), LST (lateral spreading tumor), WBC (white blood cell)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: January 13, 2016
Accepted:
January 7,
2016
Received:
May 30,
2015
Footnotes
DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.
Identification
Copyright
Copyright © 2016 by the American Society for Gastrointestinal Endoscopy
