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Management of complications related to colorectal endoscopic submucosal dissection

양동훈|Tae-Geun Gweon
대한소화기내시경학회 (The Korean Society Of Gastrointestinal Endoscopy)|2023.07|Clinical Endoscopy|제56권 제4호|pp. 423-432|DOI 10.5946/ce.2023.104

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참고문헌

키워드

HemorrhageIntestinal perforationColorectal neoplasmsIntraoperative complicationsEndoscopic submucosal dissection
주제분류내과학

초록

Compared to endoscopic mucosal resection (EMR), colonoscopic endoscopic submucosal dissection (C-ESD) has the advantages of higher en bloc resection rates and lower recurrence rates of colorectal neoplasms. Therefore, C-ESD is considered an effective treatment method for laterally spread tumors and early colorectal cancer. However, C-ESD is technically more difficult and requires a longer procedure time than EMR. In addition to therapeutic efficacy and procedural difficulty, safety concerns should always be considered when performing C-ESD in clinical practice. Bleeding and perforation are the main adverse events associated with C-ESD and can occur during C-ESD or after the completion of the procedure. Most bleeding associated with C-ESD can be managed endoscopically, even if it occurs during or after the procedure. More recently, most perforations identified during C-ESD can also be managed endoscopically, unless the mural defect is too large to be sutured with endoscopic devices or the patient is hemodynamically unstable. Delayed perforations are quite rare, but they require surgical treatment more frequently than endoscopically identified intraprocedural perforations or radiologically identified immediate postprocedural perforations. Post-ESD coagulation syndrome is a relatively underestimated adverse event, which can mimic localized peritonitis from perforation. Here, we classify and characterize the complications associated with C-ESD and recommend management options for them.

Abstract

Compared to endoscopic mucosal resection (EMR), colonoscopic endoscopic submucosal dissection (C-ESD) has the advantages of higher en bloc resection rates and lower recurrence rates of colorectal neoplasms. Therefore, C-ESD is considered an effective treatment method for laterally spread tumors and early colorectal cancer. However, C-ESD is technically more difficult and requires a longer procedure time than EMR. In addition to therapeutic efficacy and procedural difficulty, safety concerns should always be considered when performing C-ESD in clinical practice. Bleeding and perforation are the main adverse events associated with C-ESD and can occur during C-ESD or after the completion of the procedure. Most bleeding associated with C-ESD can be managed endoscopically, even if it occurs during or after the procedure. More recently, most perforations identified during C-ESD can also be managed endoscopically, unless the mural defect is too large to be sutured with endoscopic devices or the patient is hemodynamically unstable. Delayed perforations are quite rare, but they require surgical treatment more frequently than endoscopically identified intraprocedural perforations or radiologically identified immediate postprocedural perforations. Post-ESD coagulation syndrome is a relatively underestimated adverse event, which can mimic localized peritonitis from perforation. Here, we classify and characterize the complications associated with C-ESD and recommend management options for them.

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관련 논문AI추천

Management of Complications of Colorectal Submucosal Dissection김은란, Dong Kyung Chang대한소화기내시경학회 · Clinical Endoscopy2019 · 제52권 제2호Endoscopic and Clinical Factors Affecting the Prognosis of Colorectal Endoscopic Submucosal Dissection-Related PerforationByong Duk Ye, Dong-Hoon Yang, Dong-Uk Kang, Ho-Su Lee, Hyo Jeong Lee, Jeong-Sik Byeon, Jin-Ho Kim, Kyung-Jo Kim, Sang Hyoung Park, Seung-Jae Myung, Soon Man Yoon, Suk-Kyun Yang, Yun Sik Choi거트앤리버 소화기연관학회협의회 · Gut and Liver2016 · 제10권 제3호Bleeding complication after endoscopic submucosal dissection of gastric neoplasmJi Yong Ahn소화기인터벤션의학회 · International Journal of Gastrointestinal Intervention2019 · 제8권 제3호Indications for and Technical Aspects of Colorectal Endoscopic Submucosal DissectionEriko So, Masayoshi Yamada, Seiichiro Abe, Shin Haruyama, Takahisa Matsuda, Takeshi Nakajima, Taku Sakamoto, Yosuke Otake, Yutaka Saito거트앤리버 소화기연관학회협의회 · Gut and Liver2013 · 제7권 제3호Significance of rescue hybrid endoscopic submucosal dissection in difficult colorectal casesAkira Madarame, Hayato Yamaguchi, Kumiko Uchida, Masakatsu Fukuzawa, Mitsushige Sugimoto, Naoyoshi Nagata, Sakiko Naito, Shin Kono, Taisuke Matsumoto, Takahiro Muramatsu, Takao Itoi, Takashi Kawai, Takashi Morise, Yohei Koyama대한소화기내시경학회 · Clinical Endoscopy2023 · 제56권 제6호Second-look endoscopy findings after endoscopic submucosal dissection for colorectal epithelial neoplasmsBong Min Ko, Haewon Kim, Hyeon Jeong Goong, Hyo Sun Seok, Moon Sung Lee, Soo-kyung Park대한내과학회 · The Korean Journal of Internal Medicine2021 · 제36권 제5호

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