Delayed perforation after endoscopic submucosal dissection for early gastric cancer: Clinical features and treatment

Yano, Takafumi; Tanabe, Satoshi; Ishido, Kenji; Azuma, Mizutomo; Wada, Takuya; Suzuki, Mizuto; Kawanishi, Natsuko; Yamane, Sakiko; Sasaki, Takeshi; Katada, Chikatoshi; Mikami, Tetsuo; Katada, Natsuya; Koizumi, Wasaburo

doi:10.4253/wjge.v8.i8.368

Cited by 15 publications

(15 citation statements)

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“…Among the possible complications, delayed gastric perforation can occur even in cases in which no visible perforations are observed during the ESD procedure or in those with eminent clinical symptoms, suggesting that perforation occurred just after the procedure. The two types of gastric perforation after ESD can be defined according to the postprocedure time of onset: intraoperative and delayed perforation [18]. The delayed-onset type is usually found after a 5 We compared the mean operation times achieved in TU-ESD among the 3 groups (AW, PW, and LC) (A).…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, in our protocol, we assessed the healing status of the ESD sites in a full laparotomy at 7 days after the operation. Although the incidence of delayed perforation after gastric ESD is quite low (0.1% to 0.45%), it is essential to be extremely careful because in many cases, perforation requires interventions, including emergent surgery [18][19][20]. Delayed perforation might be related to necrosis of the gastric muscle and serosal layer caused by insufficient blood circulation around the dissected site.…”

Section: Discussionmentioning

confidence: 99%

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Safety and location analysis of transumbilical endoscopic submucosal dissection with single-basin lymph node dissection in the upper gastric body: a porcine model

et al. 2019

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Background In our previous study, transumbilical endoscopic submucosal dissection (TU-ESD) was revealed to be feasible, but delayed gastric perforation was observed in 30% of ESD sites. In this study, we aimed to verify locations at which it is feasible to perform TU-ESD in the upper gastric body and to demonstrate the safety of TU-ESD in single-basin lymph node dissection (SBLND). Methods In vitro, TU-ESD was performed at three lesion sites (anterior wall, AW; posterior wall, PW; and lesser curvature, LC) in each porcine stomach using an EASIE-R tray (cases = 10). In vivo, TU-ESD was performed with SBLND in 9 pigs. Seven days after the operation, the pigs were sacrificed and examined. Results In the in vitro feasibility study, the TU-ESD time was significantly faster in the PW group (5.9 ± 2.0 min) than in the LC group (8.5 ± 1.5 min) (p < 0.05) in all 10 cases. In the in vivo survival study, TU-ESD with SBLND was successfully performed without any complications (N = 9). There were no cases of delayed perforation, and healing ulcers were found in all pigs 7 days after the operation. Ulcer size (5.2 ± 3.5 cm 2 ) was approximately 36% smaller than that observed at the ESD operation site (8.1 ± 1.9 cm 2 ) (p = 0.05). Epithelialization in the margin and healing of the gastric ulcers were confirmed by microscopy.Conclusions TU-ESD with SBLND is a feasible and safe method. The upper posterior gastric body could be the most feasible location for performing TU-ESD, perhaps because of the difference in the subcutaneous dissection time.Keywords Endoscopic submucosal dissection · Single-port surgery · Gastric neoplasm · Endoscope · Laparoscopy · Porcine Although the incidence and mortality rates of gastric cancer have gradually decreased in northeast Asia, gastric cancer remains the fifth most common malignancy and the third leading cause of cancer-related deaths worldwide [1,2].The prevalence of early gastric cancer (EGC) is higher than 50% in northeast Asia because of the recently implemented screening system and advances in endoscopic diagnosis [3]. The most common site of gastric cancer is the lower onethird of the stomach, in which over half of all such cases occur in Korea; however, the proportion of recent cases of gastric cancer occurring in the upper one-third of the and Other Interventional Techniques Sang-Ho Jeong and Jae-Seok Min contributed equally to this study.Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Safety and location analysis of transumbilical endoscopic submucosal dissection with single-basin lymph node dissection in the upper gastric body: a porcine model

et al. 2019

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“…Delayed perforation occurs after completion of ESD, even when perforation is not detected during the ESD procedure. Some studies have reported rates of delayed perforation of 0.06–0.45% after gastric ESD [ 3 , 10 – 13 ]. Several case reports have also described delayed perforation after ESD for EGC [ 14 – 18 ].…”

Section: Introductionmentioning

confidence: 99%

“…Several case reports have also described delayed perforation after ESD for EGC [ 14 – 18 ]. The mechanism underlying small delayed perforation is considered to be excessive electrocautery for hemostasis [ 10 , 11 , 13 – 15 , 17 ]. The correlation between duration of cautery and delayed perforation has not previously been reported.…”

Section: Introductionmentioning

confidence: 99%

Clinical Factors of Delayed Perforation after Endoscopic Submucosal Dissection for Gastric Neoplasms

Yamamoto

Nishisaki

Sakai

et al. 2017

Gastroenterology Research and Practice

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Background Delayed perforation is a rare but severe complication of endoscopic submucosal dissection (ESD) for early gastric neoplasm (EGN). The aim of this study was to clarify clinical factors related to delayed perforation after ESD. Methods A total of 1158 consecutive patients with 1199 EGNs underwent ESD at our hospital between January 2000 and December 2015. Univariate analysis was used to identify clinicopathological factors related to delayed perforation. Moreover, duration of cautery needed for hemostasis was measured by comparison between perforated and nonperforated points in patients with delayed perforation. Results Delayed perforation occurred in 5 of 1158 consecutive patients with 1199 EGNs who underwent ESD (0.42%). All cases were diagnosed within 24 h after ESD and recovered with conservative management. On univariate analysis, location in the upper stomach was the factor most significantly associated with delayed perforation (P < 0.01). Duration of cautery needed for hemostasis was significantly longer at perforated points (9 s) than at nonperforated points (3.5 s) in five patients. Conclusions Location in the upper stomach was the risk factor most prominently associated with delayed perforation after ESD for EGNs. In addition, delayed perforation appears associated with excessive electrocautery for hemostasis.

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“…The OTSCs were visible at the scar on surveillance endoscopy 2 months later. Most patients with delayed perforation require emergency surgery [1,2]. Patients with localized peritonitis may respond to conservative therapy [1,3], but how to close a large and vulnerable perforation remains an issue.…”

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confidence: 99%

Delayed perforation after gastric endoscopic submucosal dissection can be treated by using over-the-scope clips

Kono

Kanesaka

Maekawa

et al. 2019

aog

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Delayed perforation after endoscopic submucosal dissection for early gastric cancer: Clinical features and treatment

Cited by 15 publications

References 10 publications

Safety and location analysis of transumbilical endoscopic submucosal dissection with single-basin lymph node dissection in the upper gastric body: a porcine model

Safety and location analysis of transumbilical endoscopic submucosal dissection with single-basin lymph node dissection in the upper gastric body: a porcine model

Clinical Factors of Delayed Perforation after Endoscopic Submucosal Dissection for Gastric Neoplasms

Delayed perforation after gastric endoscopic submucosal dissection can be treated by using over-the-scope clips

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