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Review
Management of complications related to colorectal endoscopic submucosal dissection
Tae-Geun Gweon, Dong-Hoon Yang
Clin Endosc 2023;56(4):423-432.   Published online July 27, 2023
DOI: https://doi.org/10.5946/ce.2023.104
AbstractAbstract PDFPubReaderePub
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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Citations to this article as recorded by  
  • International Digestive Endoscopy Network consensus on the management of antithrombotic agents in patients undergoing gastrointestinal endoscopy
    Seung Joo Kang, Chung Hyun Tae, Chang Seok Bang, Cheol Min Shin, Young-Hoon Jeong, Miyoung Choi, Joo Ha Hwang, Yutaka Saito, Philip Wai Yan Chiu, Rungsun Rerknimitr, Christopher Khor, Vu Van Khien, Kee Don Choi, Ki-Nam Shim, Geun Am Song, Oh Young Lee
    Clinical Endoscopy.2024; 57(2): 141.     CrossRef
  • Is there a best choice of equipment for colorectal endoscopic submucosal dissection?
    Francesco Cocomazzi, Sonia Carparelli, Nunzia Labarile, Antonio Capogreco, Marco Gentile, Roberta Maselli, Jahnvi Dhar, Jayanta Samanta, Alessandro Repici, Cesare Hassan, Francesco Perri, Antonio Facciorusso
    Expert Review of Medical Devices.2024; : 1.     CrossRef
  • 1,724 View
  • 130 Download
  • 4 Web of Science
  • 2 Crossref
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Original Article
Significance of rescue hybrid endoscopic submucosal dissection in difficult colorectal cases
Hayato Yamaguchi, Masakatsu Fukuzawa, Takashi Kawai, Takahiro Muramatsu, Taisuke Matsumoto, Kumiko Uchida, Yohei Koyama, Akira Madarame, Takashi Morise, Shin Kono, Sakiko Naito, Naoyoshi Nagata, Mitsushige Sugimoto, Takao Itoi
Clin Endosc 2023;56(6):778-789.   Published online July 26, 2023
DOI: https://doi.org/10.5946/ce.2022.268
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Hybrid endoscopic submucosal dissection (ESD), in which an incision is made around a lesion and snaring is performed after submucosal dissection, has some advantages in colorectal surgery, including shorter procedure time and preventing perforation. However, its value for rescue resection in difficult colorectal ESD cases remains unclear. This study evaluated the utility of rescue hybrid ESD (RH-ESD).
Methods
We divided 364 colorectal ESD procedures into the conventional ESD group (C-ESD, n=260), scheduled hybrid ESD group (SH-ESD, n=69), and RH-ESD group (n=35) and compared their clinical outcomes.
Results
Resection time was significantly shorter in the following order: RH-ESD (149 [90–197] minutes) >C-ESD (90 [60–140] minutes) >SH-ESD (52 [29–80] minutes). The en bloc resection rate increased significantly in the following order: RH-ESD (48.6%), SH-ESD (78.3%), and C-ESD (97.7%). An analysis of factors related to piecemeal resection of RH-ESD revealed that the submucosal dissection rate was significantly lower in the piecemeal resection group (25% [20%–30%]) than in the en bloc resection group (40% [20%–60%]).
Conclusions
RH-ESD was ineffective in terms of curative resection because of the low en bloc resection rate, but was useful for avoiding surgery.

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Citations to this article as recorded by  
  • Planned Hybrid Endoscopic Submucosal Dissection as Alternative for Colorectal Neoplasms: A Propensity Score-Matched Study
    Yu-xin Zhang, Xun Liu, Fang Gu, Shi-gang Ding
    Digestive Diseases and Sciences.2024; 69(3): 949.     CrossRef
  • Understanding hybrid endoscopic submucosal dissection subtleties
    João Paulo de Souza Pontual, Alexandre Moraes Bestetti, Diogo Turiani Hourneaux de Moura
    Clinical Endoscopy.2023; 56(6): 738.     CrossRef
  • 2,217 View
  • 121 Download
  • 2 Web of Science
  • 2 Crossref
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Review
Endoscopic retrograde cholangiopancreatography-related complications: risk stratification, prevention, and management
Clement Chun Ho Wu, Samuel Jun Ming Lim, Christopher Jen Lock Khor
Clin Endosc 2023;56(4):433-445.   Published online July 17, 2023
DOI: https://doi.org/10.5946/ce.2023.013
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Endoscopic retrograde cholangiopancreatography (ERCP) plays a crucial role in the management of pancreaticobiliary disorders. Although the ERCP technique has been refined over the past five decades, it remains one of the endoscopic procedures with the highest rate of complications. Risk factors for ERCP-related complications are broadly classified into patient-, procedure-, and operator-related risk factors. Although non-modifiable, patient-related risk factors allow for the closer monitoring and instatement of preventive measures. Post-ERCP pancreatitis is the most common complication of ERCP. Risk reduction strategies include intravenous hydration, rectal nonsteroidal anti-inflammatory drugs, and pancreatic stent placement in selected patients. Perforation is associated with significant morbidity and mortality, and prompt recognition and treatment of ERCP-related perforations are key to ensuring good clinical outcomes. Endoscopy plays an expanding role in the treatment of perforations. Specific management strategies depend on the location of the perforation and the patient’s clinical status. The risk of post-ERCP bleeding can be attenuated by preprocedural optimization and adoption of intra-procedural techniques. Endoscopic measures are the mainstay of management for post-ERCP bleeding. Escalation to angioembolization or surgery may be required for refractory bleeding. Post-ERCP cholangitis can be reduced with antibiotic prophylaxis in high risk patients. Bile culture-directed therapy plays an important role in antimicrobial treatment.

Citations

Citations to this article as recorded by  
  • Prevention of post-ERCP complications
    Lotfi Triki, Andrea Tringali, Marianna Arvanitakis, Tommaso Schepis
    Best Practice & Research Clinical Gastroenterology.2024; 69: 101906.     CrossRef
  • International Digestive Endoscopy Network consensus on the management of antithrombotic agents in patients undergoing gastrointestinal endoscopy
    Seung Joo Kang, Chung Hyun Tae, Chang Seok Bang, Cheol Min Shin, Young-Hoon Jeong, Miyoung Choi, Joo Ha Hwang, Yutaka Saito, Philip Wai Yan Chiu, Rungsun Rerknimitr, Christopher Khor, Vu Van Khien, Kee Don Choi, Ki-Nam Shim, Geun Am Song, Oh Young Lee
    Clinical Endoscopy.2024; 57(2): 141.     CrossRef
  • Double-guidewire technique for selective biliary cannulation does not increase the rate of post-endoscopic retrograde cholangiopancreatography pancreatitis in patients with naïve papilla
    Han Taek Jeong, June Hwa Bae, Ho Gak Kim, Jimin Han
    Clinical Endoscopy.2024; 57(2): 226.     CrossRef
  • Could assessment of genetic susceptibility be an effective solution to prevent pancreatitis from occurring after endoscopic retrograde cholangiopancreatography?
    Jae Min Lee
    The Korean Journal of Internal Medicine.2023; 38(6): 783.     CrossRef
  • 3,236 View
  • 311 Download
  • 3 Web of Science
  • 4 Crossref
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Focused Review Series: Endoscopic Managements of Postoperative Gastrointestinal Complication: What’s New?
Over-the-Scope Clip in the Treatment of Gastrointestinal Leaks and Perforations
Mike T. Wei, Ji Yong Ahn, Shai Friedland
Clin Endosc 2021;54(6):798-804.   Published online November 30, 2021
DOI: https://doi.org/10.5946/ce.2021.250
AbstractAbstract PDFPubReaderePub
While perforations, postoperative fistulas, and leaks have traditionally led to surgical or interventional radiology consultation for management, the introduction of the over-the-scope clip has allowed increased therapeutic possibilities for endoscopists. While primarily limited to case reports and series, the over-the-scope clip successfully manages gastrointestinal bleeding, perforations, as well as postoperative leaks and fistulas. Retrospective studies have demonstrated a relatively high success rate and a low complication rate. Given the similarity to variceal banding equipment, the learning curve with the over-the-scope clip is rapid. However, given the higher risk of procedures involving the use of the over-the-scope clip, it is essential to obtain the scope in a stable position and grasp sufficient tissue with the cap using a grasping tool and/or suction. From our experience, while closure may be successful in lesions sized up to 3 cm, successful outcomes are obtained for lesions sized <1 cm. Ultimately, given the limited available data, prospective randomized trials are needed to better evaluate the utility of the over-the-scope clip in various clinical scenarios, including fistula and perforation management.

Citations

Citations to this article as recorded by  
  • A Multicenter Survey of Percutaneous Endoscopic Gastrostomy in 2019 at Korean Medical Institutions
    Jun Woo Park, Tae Gyun Kim, Kwang Bum Cho, Jeong Seok Kim, Jin Woong Cho, Jung Won Jeon, Sun Gyo Lim, Chan Gyoo Kim, Hong Jun Park, Tae Jun Kim, Eun Sun Kim, Su Jin Jeong, Yong Hwan Kwon
    Gut and Liver.2024; 18(1): 77.     CrossRef
  • Clinical Practice Guideline for Percutaneous Endoscopic Gastrostomy
    Chung Hyun Tae, Ju Yup Lee, Moon Kyung Joo, Chan Hyuk Park, Eun Jeong Gong, Cheol Min Shin, Hyun Lim, Hyuk Soon Choi, Miyoung Choi, Sang Hoon Kim, Chul-Hyun Lim, Jeong-Sik Byeon, Ki-Nam Shim, Geun Am Song, Moon Sung Lee, Jong-Jae Park, Oh Young Lee
    Gut and Liver.2024; 18(1): 10.     CrossRef
  • Use of anchor pronged clips to close complex polyp resection defects
    Mike Tzuhen Wei, Shai Friedland
    VideoGIE.2023; 8(6): 245.     CrossRef
  • Novel endoscopic management of gastroenterological anastomosis leakage by injecting gel-forming solutions: an experimental animal study
    Yusuke Watanabe, Keiko Yamamoto, Zijian Yang, Haruna Tsuchibora, Masakazu Fujii, Masayoshi Ono, Shoko Ono, Takayuki Kurokawa, Naoya Sakamoto
    Surgical Endoscopy.2023; 37(10): 8029.     CrossRef
  • Clinical practice guidelines for percutaneous endoscopic gastrostomy
    Chung Hyun Tae, Ju Yup Lee, Moon Kyung Joo, Chan Hyuk Park, Eun Jeong Gong, Cheol Min Shin, Hyun Lim, Hyuk Soon Choi, Miyoung Choi, Sang Hoon Kim, Chul-Hyun Lim, Jeong-Sik Byeon, Ki-Nam Shim, Geun Am Song, Moon Sung Lee, Jong-Jae Park, Oh Young Lee
    Clinical Endoscopy.2023; 56(4): 391.     CrossRef
  • Management of complications related to colorectal endoscopic submucosal dissection
    Tae-Geun Gweon, Dong-Hoon Yang
    Clinical Endoscopy.2023; 56(4): 423.     CrossRef
  • Gastroesophageal Reflux Disease in Obesity: Bariatric Surgery as Both the Cause and the Cure in the Morbidly Obese Population
    Muaaz Masood, Donald Low, Shanley B. Deal, Richard A. Kozarek
    Journal of Clinical Medicine.2023; 12(17): 5543.     CrossRef
  • Clinical Practice Guideline for Percutaneous Endoscopic Gastrostomy
    Chung Hyun Tae, Ju Yup Lee, Moon Kyung Joo, Chan Hyuk Park, Eun Jeong Gong, Cheol Min Shin, Hyun Lim, Hyuk Soon Choi, Miyoung Choi, Sang Hoon Kim, Chul-Hyun Lim, Jeong-Sik Byeon, Ki-Nam Shim, Geun Am Song, Moon Sung Lee, Jong-Jae Park, Oh Young Lee
    The Korean Journal of Gastroenterology.2023; 82(3): 107.     CrossRef
  • Endoscopic Management of Esophageal Cancer
    Christopher Paiji, Alireza Sedarat
    Cancers.2022; 14(15): 3583.     CrossRef
  • Use of a novel dual-action clip for closure of complex endoscopic resection defects
    Mike Tzuhen Wei, Shai Friedland
    VideoGIE.2022; 7(11): 389.     CrossRef
  • 3,632 View
  • 120 Download
  • 8 Web of Science
  • 10 Crossref
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Current Status of Endoscopic Vacuum Therapy in the Management of Esophageal Perforations and Post-Operative Leaks
Imogen Livingstone, Lily Pollock, Bruno Sgromo, Sotiris Mastoridis
Clin Endosc 2021;54(6):787-797.   Published online November 16, 2021
DOI: https://doi.org/10.5946/ce.2021.240
AbstractAbstract PDFPubReaderePub
Esophageal wall defects, including perforations and postoperative leaks, are associated with high morbidity and mortality and pose a significant management challenge. In light of the high morbidity of surgical management or revision, in recent years, endoscopic vacuum therapy (EVT) has emerged as a novel alternative treatment strategy. EVT involves transoral endoscopic placement of a polyurethane sponge connected to an externalized nasogastric tube to provide continuous negative pressure with the intention of promoting defect healing, facilitating cavity drainage, and ameliorating sepsis. In the last decade, EVT has become increasingly adopted in the management of a diverse spectrum of esophageal defects. Its popularity has been attributed in part to the growing body of evidence suggesting superior outcomes and defect closure rates in excess of 80%. This growing body of evidence, coupled with the ongoing evolution of the technology and techniques of deployment, suggests that the utilization of EVT has become increasingly widespread. Here, we aimed to review the current status of the field, addressing the mechanism of action, indications, technique methodology, efficacy, safety, and practical considerations of EVT implementation. We also sought to highlight future directions for the use of EVT in esophageal wall defects.

Citations

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  • Multi-modality management of defects in the gastrointestinal tract: Where the endoscope meets the scalpel: Endoscopic vacuum therapy in the upper gastrointestinal tract
    Lisanne M.D. Pattynama, Wietse J. Eshuis, Stefan Seewald, Roos E. Pouw
    Best Practice & Research Clinical Gastroenterology.2024; : 101901.     CrossRef
  • Management of esophageal anastomotic leaks, a systematic review and network meta-analysis
    William Murray, Mathew G Davey, William Robb, Noel E Donlon
    Diseases of the Esophagus.2024;[Epub]     CrossRef
  • Management of an Aortoesophageal Fistula With Esophageal Endoluminal Wound Vacuum Therapy
    Antoine Nehme, Samuel Brown, Salman Zaheer, Alexander Leung
    Annals of Thoracic Surgery Short Reports.2024;[Epub]     CrossRef
  • Treatment of Esophageal-Pleural Fistula After Diverticulectomy Using Transluminal Vacuum Therapy in a Patient with HIV Infection
    M. A. Panasyuk, G. Yu. Aldaranov, V. N. Makhutov, E. G. Grigoriev
    Russian Sklifosovsky Journal "Emergency Medical Care".2024; 13(1): 156.     CrossRef
  • Homemade endoscopic vacuum therapy device for the management of transmural gastrointestinal defects
    Diogo Turiani Hourneaux de Moura, Bruno Salomão Hirsch, Thomas R. McCarty, Marcos Eduardo Lera dos Santos, Hugo Gonçalo Guedes, Guilherme Francisco Gomes, Flaubert Sena de Medeiros, Eduardo Guimarães Hourneaux de Moura
    Digestive Endoscopy.2023; 35(6): 745.     CrossRef
  • Choosing the best endoscopic approach for post-bariatric surgical leaks and fistulas: Basic principles and recommendations
    Victor Lira de Oliveira, Alexandre Moraes Bestetti, Roberto Paolo Trasolini, Eduardo Guimarães Hourneaux de Moura, Diogo Turiani Hourneaux de Moura
    World Journal of Gastroenterology.2023; 29(7): 1173.     CrossRef
  • Vacuum-Assisted Closure Treats Refractory Esophageal Leak in a Pediatric Patient
    Evan K Lin, Felicia Lee, Jasmin Cao, Christian Saliba, Vivian Lu, Raymond I Okeke, Justin Sobrino, Christopher Blewett
    Cureus.2023;[Epub]     CrossRef
  • Esophageal Perforation
    Kelly Fairbairn, Stephanie G. Worrell
    Thoracic Surgery Clinics.2023; 33(2): 117.     CrossRef
  • Endoscopic Treatment of Non-malignant Esophageal Perforation: Time to Go Vacuum?
    Diogo Turiani Hourneaux de Moura, Bruno Salomão Hirsch, Heli Clóvis de Medeiros Neto, Victor Lira de Oliveira, Alexandre Moraes Bestetti, Bruna Furia Buzetti Hourneaux de Moura, Mouen A. Khashab, Eduardo Guimarães Hourneaux de Moura
    Current Treatment Options in Gastroenterology.2023; 21(2): 95.     CrossRef
  • Prophylactic endoluminal vacuum therapy after major gastrointestinal surgery: a systematic review
    Olga Adamenko, Carlo Ferrari, Stefan Seewald, Jan Schmidt
    Updates in Surgery.2022; 74(4): 1177.     CrossRef
  • Endoscopic Management of Esophageal Cancer
    Christopher Paiji, Alireza Sedarat
    Cancers.2022; 14(15): 3583.     CrossRef
  • 4,571 View
  • 239 Download
  • 7 Web of Science
  • 11 Crossref
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Case Reports
Endoscopic Treatment of Iatrogenic Perforation of Sigmoid Diverticulum: A Case Report of Multidisciplinary Management
Giacomo Emanuele Maria Rizzo, Giuseppina Ferro, Giovanna Rizzo, Giovanni Di Carlo, Alessandro Cantone, Gaetano Giuseppe Di Vita, Carmelo Sciumè
Clin Endosc 2022;55(2):292-296.   Published online June 7, 2021
DOI: https://doi.org/10.5946/ce.2021.005
AbstractAbstract PDFPubReaderePub
Iatrogenic perforations are severe complications of gastrointestinal endoscopy; therefore, their management should be adequately planned. A 77-year-old man with a history of diverticulosis underwent a colonoscopy for anemia. During the procedure, an iatrogenic perforation occurred suddenly in the sigmoid colon, near a severe angle among the numerous diverticula. Through-the-scope clips were immediately applied to treat it and close mucosal edges. Laboratory tests showed increased levels of inflammation and infection, and although there were no complaints of abdominal pain, the patient had an extremely distended abdomen. A multidisciplinary board began management based on a conservative approach. Pneumoperitoneum was treated with computed tomography-assisted drainage. After 72 hours, his intestinal canalization and laboratory tests were normal. Though this adverse event is rare, a multidisciplinary board should be promptly gathered upon occurrence, even if the patient appears clinically stable, to consider a conservative approach and avoid surgical treatment.
  • 3,550 View
  • 161 Download
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Intestinal Perforation Caused by Lumboperitoneal Shunt Insertion Repaired with an Over-the-Scope Clip
Naoki Ishizuka, Eiji Komatsu
Clin Endosc 2022;55(1):146-149.   Published online March 3, 2021
DOI: https://doi.org/10.5946/ce.2020.293
AbstractAbstract PDFPubReaderePub
Lumboperitoneal or ventriculoperitoneal shunt insertion is a standard therapy for hydrocephalus that diverts cerebrospinal fluid from the subarachnoid space into the peritoneal cavity. Gastrointestinal perforations due to this procedure occur rarely; however, accepted treatment strategies have not yet been established. Hence, the most common treatment approaches are open surgery or spontaneous closure without endoscopy. We report the case of a small intestinal perforation in a 73-year-old-woman that occurred after the insertion of a lumboperitoneal shunt. A positive cerebrospinal fluid culture and high cerebrospinal fluid white blood cell count indicated a retrograde bacterial infection, and computed tomography revealed that the peritoneal tip of the shunt catheter was located in the lumen of the gastrointestinal tract. We repaired the perforation endoscopically using an over-the-scope clip, and the patient’s recovery was uneventful. Use of an over-the-scope clip could be an effective and minimally invasive treatment for intestinal perforations caused by lumboperitoneal or ventriculoperitoneal shunt insertion.

Citations

Citations to this article as recorded by  
  • Progress in Surgical Treatment of Traffic Hydrocephalus
    飞 张
    Advances in Clinical Medicine.2021; 11(09): 3942.     CrossRef
  • 2,979 View
  • 136 Download
  • 1 Crossref
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Original Article
Diode Laser—Can It Replace the Electrical Current Used in Endoscopic Submucosal Dissection?
Yunho Jung, Gwang Ho Baik, Weon Jin Ko, Bong Min Ko, Seong Hwan Kim, Jin Seok Jang, Jae-Young Jang, Wan-Sik Lee, Young Kwan Cho, Sun Gyo Lim, Hee Seok Moon, In Kyung Yoo, Joo Young Cho
Clin Endosc 2021;54(4):555-562.   Published online January 13, 2021
DOI: https://doi.org/10.5946/ce.2020.229
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: A new medical fiber-guided diode laser system (FDLS) is expected to offer high-precision cutting with simultaneous hemostasis. Thus, this study aimed to evaluate the feasibility of using the 1,940-nm FDLS to perform endoscopic submucosal dissection (ESD) in the gastrointestinal tract of an animal model.
Methods
In this prospective animal pilot study, gastric and colorectal ESD using the FDLS was performed in ex vivo and in vivo porcine models. The completeness of en bloc resection, the procedure time, intraprocedural bleeding, histological injuries to the muscularis propria (MP) layer, and perforation were assessed.
Results
The en bloc resection and perforation rates in the ex vivo study were 100% (10/10) and 10% (1/10), respectively; those in the in vivo study were 100% (4/4) and 0% for gastric ESD and 100% (4/4) and 25% (1/4) for rectal ESD, respectively. Deep MP layer injuries tended to occur more frequently in the rectal than in the gastric ESD cases, and no intraprocedural bleeding occurred in either group.
Conclusions
The 1,940-nm FDLS was capable of yielding high en bloc resection rates without intraprocedural bleeding during gastric and colorectal ESD in animal models.

Citations

Citations to this article as recorded by  
  • Use of Diode Laser in Hysteroscopy for the Management of Intrauterine Pathology: A Systematic Review
    Andrea Etrusco, Giovanni Buzzaccarini, Antonio Simone Laganà, Vito Chiantera, Salvatore Giovanni Vitale, Stefano Angioni, Maurizio Nicola D’Alterio, Luigi Nappi, Felice Sorrentino, Amerigo Vitagliano, Tommaso Difonzo, Gaetano Riemma, Liliana Mereu, Alessa
    Diagnostics.2024; 14(3): 327.     CrossRef
  • Recent advances in endoscopic management of gastric neoplasms
    Hira Imad Cheema, Benjamin Tharian, Sumant Inamdar, Mauricio Garcia-Saenz-de-Sicilia, Cem Cengiz
    World Journal of Gastrointestinal Endoscopy.2023; 15(5): 319.     CrossRef
  • Safety and efficacy of dual emission endoscopic laser treatment in patients with upper or lower gastrointestinal vascular lesions causing chronic anemia: results from the first multicenter cohort study
    Gian Eugenio Tontini, Lorenzo Dioscoridi, Alessandro Rimondi, Paolo Cantù, Flaminia Cavallaro, Aurora Giannetti, Luca Elli, Luca Pastorelli, Francesco Pugliese, Massimiliano Mutignani, Maurizio Vecchi
    Endoscopy International Open.2022; 10(04): E386.     CrossRef
  • 3,882 View
  • 110 Download
  • 3 Web of Science
  • 3 Crossref
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Case Report
Perforation of a Gastric Tear during Esophageal Endoscopic Submucosal Dissection under General Anesthesia
Tomoaki Yamasaki, Yuhei Sakata, Takehisa Suekane, Hiroko Nebiki
Clin Endosc 2021;54(6):916-919.   Published online November 12, 2020
DOI: https://doi.org/10.5946/ce.2020.220
AbstractAbstract PDFPubReaderePub
Mallory-Weiss tears (MWT) are occasionally encountered during endoscopic procedures. Esophageal endoscopic submucosal dissection (ESD) is widely performed under general anesthesia to avoid unexpected body movements. We present the case of a 68-year-old woman with squamous cell carcinoma. Although ESD was performed under general anesthesia, a gastric perforation at the MWT caused by gastric inflation was observed after the procedure. The perforation was closed endoscopically, and she was discharged without any sequelae. Although general anesthesia is useful for esophageal ESD, it should be noted that it can cause MWT, and in rare cases, gastric perforation, due to gastric inflation during the procedure.

Citations

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  • Gastric Perforation Encountered during Duodenal Stent Insertion
    Sung Woo Ko, Hoonsub So, Sung Jo Bang
    The Korean Journal of Gastroenterology.2022; 80(5): 221.     CrossRef
  • 3,796 View
  • 77 Download
  • 1 Web of Science
  • 1 Crossref
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Original Article
Dedicated Cold Snare vs. Traditional Snare for Polypectomy of Diminutive and Small Lesions in a Porcine Model: A Research Group for Endoscopic Instruments and Stents (REIS) Study
Han Hee Lee, Bo-In Lee, Jung-Wook Kim, Hyun Lim, Si Hyung Lee, Jun-Hyung Cho, Yunho Jung, Kyoung Oh Kim, Chan Gyoo Kim, Kee Myung Lee, Jong-Jae Park, Myung-Gyu Choi, Hoon Jai Chun, Ho Gak Kim
Clin Endosc 2021;54(3):390-396.   Published online September 10, 2020
DOI: https://doi.org/10.5946/ce.2020.096
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: The aim of this in vivo animal study was to evaluate the effectiveness and safety of dedicated cold snare (DCS) compared with those of traditional snare (TS) for cold snare polypectomy (CSP).
Methods
A total of 36 diminutive (5 mm) and 36 small (9 mm) pseudolesions were made by electrocoagulation in the colons of mini-pigs.
Results
For the diminutive lesions, there were no significant differences in technical success rate, procedure time, or complete resection rate between the DCS and TS groups; the rate of uneven resection margin in the DCS group was significantly lower than that of the TS group. For small lesions, technical success rate and complete resection rate were significantly higher in the DCS group than in the TS group (100% [18/18] vs. 55.6% [10/18], p=0.003; 94.4% [17/18] vs. 40% [4/10], p=0.006). In addition, the procedure duration was significantly shorter, and the rate of uneven resection margin was significantly lower in the DCS group (28.5 sec vs. 66.0 sec, p=0.006; 11.1% [2/18] vs. 100% [10/10], p<0.001). Two cases of perforation occurred in the DCS group. Multivariate analysis revealed that DCS use was independently associated with complete resection.
Conclusions
DCS is superior to TS in terms of technical success, complete resection, and reducing the duration of the procedure for CSP of small polyps.

Citations

Citations to this article as recorded by  
  • Comparison of complete resection rates in cold snare polypectomy using two different wire diameter snares: A randomized controlled study
    Toshiki Horii, Sho Suzuki, Akihiro Sugita, Misa Yamauchi, Hisatomo Ikehara, Chika Kusano, Takuji Gotoda
    Journal of Gastroenterology and Hepatology.2023; 38(5): 752.     CrossRef
  • Comparison of the clinical efficacy of cold snare polypectomy using a thin-wire snare and thick-wire snare for small colorectal polyps
    Hong Jin Yoon, Yunho Jung, Young Sin Cho, Il-Kwun Chung
    International Journal of Gastrointestinal Intervention.2023; 12(4): 183.     CrossRef
  • Big Issues on Small Polyps: An Ideal Device, But Is It for an Ideal Indication?
    Yoji Takeuchi
    Clinical Endoscopy.2021; 54(3): 297.     CrossRef
  • Cold versus hot polypectomy/endoscopic mucosal resection–A review of current evidence
    Raquel Ortigão, Jochen Weigt, Ahmed Afifi, Diogo Libânio
    United European Gastroenterology Journal.2021; 9(8): 938.     CrossRef
  • 8,391 View
  • 221 Download
  • 4 Web of Science
  • 4 Crossref
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Focused Review Series: The Roles of Endoscopy in the Management of Colonic Obstruction and Perforation
Endoscopic Management of Iatrogenic Colon Perforation
Yunho Jung
Clin Endosc 2020;53(1):29-36.   Published online July 3, 2019
DOI: https://doi.org/10.5946/ce.2019.061
AbstractAbstract PDFPubReaderePub
Colon perforations are difficult to resolve because they occur unexpectedly and infrequently. If the clinician is unprepared or lacks training in dealing with perforations, the clinical prognosis will be affected, which can lead to legal issues. We describe here the proper approach to the management of perforations, including deciding on endoscopic or surgical treatment, selection of endoscopic devices, endoscopic closure procedures, and general management of perforations that occur during diagnostic or therapeutic colonoscopy.

Citations

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  • Closure of gastrointestinal perforations using an endoloop system and a single-channel endoscope: description of a simple, reproducible, and standardized method
    Flavius-Stefan Marin, Antoine Assaf, Paul Doumbe-Mandengue, Einas Abou Ali, Arthur Belle, Romain Coriat, Stanislas Chaussade
    Surgical Endoscopy.2024;[Epub]     CrossRef
  • Endoclip combined with colonic transendoscopic enteral tubing: a new approach for managing iatrogenic colonoscopy perforation
    Xiaomeng Jiang, Chunhua Ni, Fatema Tabak, Yi Li, Faming Zhang
    Surgical Endoscopy.2024; 38(3): 1647.     CrossRef
  • Management of complications related to colorectal endoscopic submucosal dissection
    Tae-Geun Gweon, Dong-Hoon Yang
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Focused Review Series: Endoscopic Submucosal Dissection for Colorectal Tumors
Management of Complications of Colorectal Submucosal Dissection
Eun Ran Kim, Dong Kyung Chang
Clin Endosc 2019;52(2):114-119.   Published online March 29, 2019
DOI: https://doi.org/10.5946/ce.2019.063
AbstractAbstract PDFPubReaderePub
Endoscopic submucosal dissection (ESD) is a useful procedure for the treatment of superficial gastrointestinal neoplasm. Compared with endoscopic mucosal resection (EMR), ESD has several benefits, which include resectability of various difficult lesion, accurate histologic assessment of specimen, and lower recurrence rate. However, the risk of procedure- related complications is higher with ESD than with EMR. Moreover, because the colon has a thin wall and limited endoscopic maneuverability, ESD is considered a more challenging and risky procedure when performed in the colon than in the stomach. ESD-related complications are more likely to occur. The significant complications associated with ESD are bleeding, perforation, coagulation syndrome and stenosis, most of which can be treated and prevented by endoscopic intervention and preparation. Therefore, it is important to know how to occur and manage the ESD related complication.

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Case Reports
Stomach Perforation Caused by Ingesting Liquid Nitrogen: A Case Report on the Effect of a Dangerous Snack
Dong-Wook Kim
Clin Endosc 2018;51(4):381-383.   Published online March 5, 2018
DOI: https://doi.org/10.5946/ce.2017.178
AbstractAbstract PDFPubReaderePub
We report our experience with a case of stomach perforation after accidental ingestion of liquid nitrogen. A 13-year-old boy ate a snack at an amusement park and began to complain of sudden onset of severe abdominal pain with shortness of breath. It was determined that the snack he had ingested had been cooled with liquid nitrogen. A computed tomography scan of the abdomen and a chest X-ray showed a large volume of pneumoperitoneum. During surgery, a 4-cm perforation of the angularis incisura of the stomach was identified. Primary repair and omentopexy was performed. The patient was discharged without postoperative complications.

Citations

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An Unusual Case of Ovarian Carcinomatosis with Microscopic Tumor Embolism Leading to Rectal Ischemia and Perforation
Man Hon Tang, Jason Lim, Inny Bushmani, Chee Yung Ng
Clin Endosc 2018;51(3):294-298.   Published online February 22, 2018
DOI: https://doi.org/10.5946/ce.2017.152
AbstractAbstract PDFPubReaderePub
We present an unusual case of advanced ovarian carcinoma with postoperative complications of ischemia and perforation of the rectum as a result of tumor embolism. The interval progression from ischemia to infarction of the rectum was captured in repeated sigmoidoscopies. A brief discussion on tumor embolism and management of this case is also included.

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    Patrick Harnarayan, Shariful Islam, Vijay Naraynsingh
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Close layer
Role of Endoscopy in the Management of Boerhaave Syndrome
Juan Ignacio Tellechea, Jean-Michel Gonzalez, Pablo Miranda-García, Adrian Culetto, Xavier Benoit D’Journo, Pascal Alexandre Thomas, Marc Barthet
Clin Endosc 2018;51(2):186-191.   Published online September 20, 2017
DOI: https://doi.org/10.5946/ce.2017.043
AbstractAbstract PDFPubReaderePub
Boerhaave syndrome (BS) is a spontaneous esophageal perforation which carries high mortality. Surgical treatment is well established, but the development of interventional endoscopy has proposed new therapies. We expose our experience in a Gastrointestinal and Endoscopy Unit. With a retrospective, observational, open-label, single center, consecutive case series. All patients diagnosed with BS who were managed in our center were included. Treated conservatively, endoscopically or surgically, according to their clinical condition and lesion presentation. Fourteen patients were included. Ten were treated with primary surgery. One conservatively. In total, 7/14 patients required an endoscopic treatment. All required metallic stents deployment, 3 cases over-the-scope-clips concomitantly and one case a novel technique an internal drain. 6/7 cases endoscopically treated achieved complete esophageal healing. In conclusion, endoscopy is an useful tool at all stages BS management: difficult diagnosis, primary treatment in selected patients and as salvage when surgery fails. With mortality rates and outcomes comparables to surgery.

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    Mª Henar Núñez Rodríguez, Fátima Sánchez Martin, Rodrigo Nájera, Pilar Diez Redondo
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    Divya Chalikonda, Joseph Yoo, Drew Johnson, Christina Tofani
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  • WITHDRAWN: Over-the-scope clip: Endoscopic treatment of Boerhaave syndrome
    Mª Henar Núñez Rodríguez, Fátima Sánchez Martin, Rodrigo Nájera, Pilar Diez Redondo
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  • Over-the-scope-clip: Endoscopic treatment of Boerhaave syndrome
    Mª Henar Núñez Rodríguez, Fátima Sánchez Martin, Rodrigo Nájera, Pilar Diez Redondo
    Gastroenterología y Hepatología (English Edition).2019; 42(9): 564.     CrossRef
  • 6,341 View
  • 267 Download
  • 15 Web of Science
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Close layer
Original Article
Efficacy of the Over-the-Scope Clip System for Treatment of Gastrointestinal Fistulas, Leaks, and Perforations: A Korean Multi-Center Study
Hang Lak Lee, Joo Young Cho, Jun-Hyung Cho, Jong Jae Park, Chan Gyoo Kim, Seong Hwan Kim, Joung-Ho Han
Clin Endosc 2018;51(1):61-65.   Published online August 29, 2017
DOI: https://doi.org/10.5946/ce.2017.027
AbstractAbstract PDFPubReaderePub
Background
/Aims: Currently, a new over-the-scope clip (OTSC) system has been introduced. This system has been used for gastrointestinal perforations and fistulas in other countries. The aim of our study is to examine the therapeutic success rate of endoscopic treatment using the OTSC system in Korea.
Methods
This was a multicenter prospective study. A total of seven endoscopists at seven centers performed this procedure.
Results
A total of 19 patients were included, with gastrointestinal leakages from anastomosis sites, fistulas, or esophageal perforations due to Boerhaave’s syndrome. Among these, there were three gastrojejunostomy sites, three esophagojejunostomy sites, four esophagogastrostomy sites, one esophagocolonostomy site, one jejuno-jejunal site, two endoscopic full thickness resection site closures, one Boerhaave’s syndrome, two esophago-bronchial fistulas, one gastrocolonic fistula, and one colonopseudocyst fistula. The size of the leakage ranged from 5 to 30 mm. The median procedure time was 16 min. All cases were technically successful. Complete closure of the leak was achieved in 14 of 19 patients using OTSC alone.
Conclusions
The OTSC system is a safe and effective method for the management of gastrointestinal leakage, especially in cases of anastomotic leakage after surgery.

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    Nicholas Bartell, Krystle Bittner, Vivek Kaul, Truptesh H Kothari, Shivangi Kothari
    World Journal of Gastroenterology.2020; 26(24): 3495.     CrossRef
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    Allison R. Schulman, Rabindra R. Watson, Barham K. Abu Dayyeh, Manoop S. Bhutani, Vinay Chandrasekhara, Pichamol Jirapinyo, Kumar Krishnan, Nikhil A. Kumta, Joshua Melson, Rahul Pannala, Mansour A. Parsi, Guru Trikudanathan, Arvind J. Trindade, John T. Ma
    Gastrointestinal Endoscopy.2020; 92(3): 492.     CrossRef
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    Teresa Marzia Rogger, Andrea Michielan, Sandro Sferrazza, Cecilia Pravadelli, Luisa Moser, Flora Agugiaro, Giovanni Vettori, Sonia Seligmann, Elettra Merola, Marcello Maida, Francesco Antonio Ciarleglio, Alberto Brolese, Giovanni de Pretis
    World Journal of Gastroenterology.2020; 26(35): 5375.     CrossRef
  • Over‐the‐scope clip system: A review of 1517 cases over 9 years
    Hideki Kobara, Hirohito Mori, Noriko Nishiyama, Shintaro Fujihara, Keiichi Okano, Yasuyuki Suzuki, Tsutomu Masaki
    Journal of Gastroenterology and Hepatology.2019; 34(1): 22.     CrossRef
  • Recent advancements in the minimally invasive management of esophageal perforation, leaks, and fistulae
    Shirin Siddiqi, Dean P. Schraufnagel, Hafiz Umair Siddiqui, Michael J. Javorski, Adam Mace, Abdulrhman S. Elnaggar, Haytham Elgharably, Patrick R. Vargo, Robert Steffen, Saad M. Hasan, Siva Raja
    Expert Review of Medical Devices.2019; 16(3): 197.     CrossRef
  • Diagnosis and endoscopic treatment of esophageal leakage: a systematic review
    Bram D. Vermeulen, Peter D. Siersema
    Techniques in Gastrointestinal Endoscopy.2019; 21(2): 58.     CrossRef
  • Management of esophagojejunal anastomosis leakage after total gastrectomy
    Pablo Priego, Pietro Giordano, Marta Cuadrado, Araceli Ballestero, Julio Galindo, Eduardo Lobo
    European Surgery.2018; 50(6): 262.     CrossRef
  • Endoluminal Therapies for Esophageal Perforations and Leaks
    Jeffrey R. Watkins, Alexander S. Farivar
    Thoracic Surgery Clinics.2018; 28(4): 541.     CrossRef
  • Esophageal leaks: I thought that glue was not effective
    Ignacio Fernández-Urién, Juan Vila
    Endoscopy International Open.2018; 06(09): E1100.     CrossRef
  • 7,581 View
  • 324 Download
  • 26 Web of Science
  • 27 Crossref
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Case Report
Gastric Perforation Caused by an Intragastric Balloon: Endoscopic Findings
In Kyung Yoo, Hoon Jai Chun, Yoon Tae Jeen
Clin Endosc 2017;50(6):602-604.   Published online May 18, 2017
DOI: https://doi.org/10.5946/ce.2017.015
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Intragastric balloon (IGB) insertion has been most frequently used in the West as an effective endoscopic treatment for morbid obesity, in practice. Recently, there is a growing number of cases requiring IGB deployment for obesity treatment in Korea. One of the reported complications of IGB use is gastric perforation. A 47-year-old woman was admitted to the hospital with mild symptoms, 7 weeks after having an IGB placed. Esophagogastroduodenoscopy was performed and gastric ulcer perforation was observed in the ulcer base, where food particles were impacted. Laparoscopic primary repair was done successfully. This was a case of gastric perforation, secondary to poor compliance with a proton-pump inhibitor (PPI). PPI and Helicobacter pylori eradication are important for ulcer prevention following IGB deployment.

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  • Common, Less Common, and Unexpected Complications after Bariatric Surgery: A Pictorial Essay
    Francesca Iacobellis, Giuseppina Dell’Aversano Orabona, Antonio Brillantino, Marco Di Serafino, Alessandro Rengo, Paola Crivelli, Luigia Romano, Mariano Scaglione
    Diagnostics.2022; 12(11): 2637.     CrossRef
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    Dominic A Staudenmann, Zhixian Sui, Payal Saxena, Arthur J Kaffes, George Marinos, Vivek Kumbhari, Patrick Aepli, Adrian Sartoretto
    Medical Journal of Australia.2021; 215(4): 183.     CrossRef
  • Stomach Volume Assessment Using Three-dimensional Computed Tomography Gastrography for Bariatric Treatment
    Seung Han Kim, Bora Keum, Hyuk Soon Choi, Eun Sun Kim, Yeon Seok Seo, Yoon Tae Jeen, Hong Sik Lee, Hoon Jai Chun, Soon Ho Um, Chang Duck Kim
    Obesity Surgery.2020; 30(2): 401.     CrossRef
  • COMBINED ENDOSCOPY AND LAPAROSCOPIC APPROACH OF A GASTRIC PERFORATION DUE TO INTRAGASTRIC BALLOON INSERTION
    Guillermo Perez Aguado, José Carlos Cabrera Marrero, Lucía Jiménez-Ruano
    Revista Española de Enfermedades Digestivas.2020;[Epub]     CrossRef
  • The role of silent helicobacter pylori infection in intragastric ulcers induced by balloon insertion used for management of obesity
    Tamer Haydara, Ahmed M. Kabel, Ayman M. Elsaka
    Diabetes & Metabolic Syndrome: Clinical Research & Reviews.2019; 13(1): 116.     CrossRef
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    Ryan Windish, Jason Wong
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    Hang Lak Lee
    Clinical Endoscopy.2018; 51(5): 416.     CrossRef
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    Larrite Reed, Hawa Edriss, Kenneth Nugent
    Clinical Endoscopy.2018; 51(6): 584.     CrossRef
  • Exclusively endoscopic approach to treating gastric perforation caused by an intragastric balloon: case series and literature review
    Sérgio Alexandre Barrichello Junior, Igor Braga Ribeiro, Ricardo José Fittipaldi-Fernandez, Ana Carolina Hoff, Diogo Turiani Hourneaux de Moura, Mauricio Kazuyoshi Minata, Thiago Ferreira de Souza, Manoel dos Passos Galvão Neto, Eduardo Guimarães Hourneau
    Endoscopy International Open.2018; 06(11): E1322.     CrossRef
  • 6,334 View
  • 171 Download
  • 10 Web of Science
  • 9 Crossref
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Review
Pneumothorax after Colonoscopy – A Review of Literature
Ajay Gupta, Hammad Zaidi, Khalid Habib
Clin Endosc 2017;50(5):446-450.   Published online April 10, 2017
DOI: https://doi.org/10.5946/ce.2016.118
AbstractAbstract PDFPubReaderePub
The purpose of this study was to determine the anatomical aspects, mechanisms, risk factors and appropriate management of development of pneumothorax during a routine colonoscopy. A systematic search of the literature (MEDLINE, Embase and Google Scholar) revealed 21 individually documented patients of pneumothorax following a colonoscopy, published till December 2015. One additional patient treated at our center was added. A pooled analysis of these 22 patients was performed including patient characteristics, indication of colonoscopy, any added procedure, presenting symptoms,risk factors and treatment given. The review suggested that various risk factors may be female gender, therapeutic interventions, difficult colonoscopy and underlying bowel pathology. Diagnosis of this condition requires a high index of suspicion and treatment should be tailored to individual needs.

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  • A CASE OF PNEUMOTHORAX AFTER COLONOSCOPIC POLYPECTOMY: A CASE REPORT AND REVIEW OF THE LITERATURE
    Mehmet Ası Oktan, Cenk Emre Meral, Atakan Arslan, Yasemin Kaya, Batuhan Hazer, Bahattin Tuncalı
    Gastroenterology Nursing.2024; 47(3): 217.     CrossRef
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  • 6,999 View
  • 136 Download
  • 5 Web of Science
  • 4 Crossref
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Case Reports
Endoscopic Management of Gastrointestinal Leaks and Perforation with Polyglycolic Acid Sheets
Sojung Han, Hyunsoo Chung, Jun Chul Park, Sung Kwan Shin, Sang Kil Lee, Yong Chan Lee
Clin Endosc 2017;50(3):293-296.   Published online March 8, 2017
DOI: https://doi.org/10.5946/ce.2016.121
AbstractAbstract PDFPubReaderePub
Gastrointestinal (GI) leakage, fistulae, and perforations can be serious and life threatening. There has been a paradigm shift in the management approach of these conditions, from surgical to conservative, including endoscopic management. Here, we report two cases of endoscopic closure of a GI fistula and perforation using polyglycolic acid (PGA) sheets with fibrin glue. The first case is of an anastomotic leak detected after subtotal gastrectomy with gastroduodenostomy. After failed application of endoclips, a PGA sheet was applied, and the fistula was successfully closed. The second case was of a 15-mm large perforated gastric ulcer, which was also successfully closed with a PGA sheet. This is the first case report that PGA sheet was used for the treatment of overt perforation. The outcome of these cases suggest that endoscopic closure using PGA sheets can be considered as a useful alternative for the management of GI leakage, fistulae, and perforations.

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  • A Randomized Controlled Trial of Fibrin Glue to Prevent Bleeding After Gastric Endoscopic Submucosal Dissection
    Hyun Deok Lee, Eunwoo Lee, Sang Gyun Kim, Cheol Min Shin, Jun Chul Park, Kee Don Choi, Seokyung Hahn, Soo-Jeong Cho
    American Journal of Gastroenterology.2023; 118(5): 892.     CrossRef
  • Large anastomotic leak: endoscopic treatment using combined fibrin glue and polyglycolic acid (PGA) sheets
    Soo In Choi, Ji Young Park
    BMJ Case Reports.2021; 14(8): e240188.     CrossRef
  • The treatment for refractory rectovaginal fistula after low anterior resection with estriol, polyglycolic acid sheets and primary closure: A case report
    Masatsugu Hiraki, Toshiya Tanaka, Tadayuki Kanai, Takuya Shimamura, Osamu Ikeda, Makio Yasunaga, Shinichi Ogata, Kenji Kitahara
    International Journal of Surgery Case Reports.2020; 75: 483.     CrossRef
  • Endoscopic management of esophagorespiratory fistulas
    Brian Larson, Douglas G. Adler
    Techniques in Gastrointestinal Endoscopy.2019; 21(2): 65.     CrossRef
  • Endoscopic closure of an anastomo-cutaneous fistula: Filling and shielding using polyglycolic acid sheets and fibrin glue with easily deliverable technique
    Hideaki Kawabata, Yuji Okazaki, Naonori Inoue, Yukino Kawakatsu, Misuzu Hitomi, Masatoshi Miyata, Shigehiro Motoi
    Endoscopy International Open.2018; 06(08): E994.     CrossRef
  • Successful Endoscopic Closure Using Polyglycolic Acid Sheets with Fibrin Glue for Nonhealing Duodenal Ulcer with Perforation after Proton Beam Therapy of Liver Tumor
    Ko Watanabe, Takuto Hikichi, Jun Nakamura, Minami Hashimoto, Tadayuki Takagi, Rei Suzuki, Mitsuru Sugimoto, Naoki Konno, Mika Takasumi, Yuki Sato, Hiroki Irie, Takashi Kimura, Akira Kenjo, Shigeru Marubashi, Katsutoshi Obara, Hiromasa Ohira
    Case Reports in Gastroenterology.2018; 12(3): 679.     CrossRef
  • 7,809 View
  • 222 Download
  • 7 Web of Science
  • 6 Crossref
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Repair of an Endoscopic Retrograde Cholangiopancreatography-Related Large Duodenal Perforation Using Double Endoscopic Band Ligation and Endoclipping
Keunmo Kim, Eun Bee Kim, Yong Hyeok Choi, Youngmin Oh, Joung-Ho Han, Seon Mee Park
Clin Endosc 2017;50(2):202-205.   Published online September 13, 2016
DOI: https://doi.org/10.5946/ce.2016.112
AbstractAbstract PDFPubReaderePub
Endoscopic closure techniques have been introduced for the repair of duodenal wall perforations that occur during endoscopic retrograde cholangiopancreatography (ERCP). We report a case of successful repair of a large duodenal wall perforation by using double endoscopic band ligation (EBL) and an endoclip. Lateral duodenal wall perforation occurred during ERCP in a 93-year-old woman with acute calculous cholangitis. We switched to a forward endoscope that had a transparent band apparatus. A 2.0-cm ovalshaped perforation was found at the lateral duodenal wall. We repaired the perforation by sequentially performing double EBL and endoclipping. The first EBL was performed at the proximal edge of the perforation orifice, and two-thirds of the perforation were repaired. The second EBL, which also included the contents covered under the first EBL, repaired the defect almost completely. Finally, to account for the possible presence of a residual perforation, an endoclip was applied at the distal end of the perforation. The detection and closure of the perforation were completed within 10 minutes. We suggest that double EBL is an effective method for closure.

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  • Endoscopic treatment of ERCP-related duodenal perforation
    Nicole Evans, James L. Buxbaum
    Techniques in Gastrointestinal Endoscopy.2019; 21(2): 83.     CrossRef
  • 8,832 View
  • 183 Download
  • 2 Web of Science
  • 1 Crossref
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Reviews
Endoscopic Closure for Full-Thickness Gastrointestinal Defects: Available Applications and Emerging Innovations
Nobuyoshi Takeshita, Khek Yu Ho
Clin Endosc 2016;49(5):438-443.   Published online August 30, 2016
DOI: https://doi.org/10.5946/ce.2016.104
AbstractAbstract PDFPubReaderePub
Full-thickness gastrointestinal defects such as perforation, anastomotic leak, and fistula are severe conditions caused by various types of pathologies. They are more likely to require intensive care and a long hospital stay and have high rates of morbidity and mortality. After intentional full-thickness opening of hollow organs for natural orifice transluminal endoscopic surgery, safe and secure closure is urgently required. The currently available advanced endoscopic closing techniques have a major role in the treatment of full-thickness gastrointestinal defects. Appropriate usage of these techniques requires taking into account their advantages and limitations during practical application. We reviewed the available endoscopic modalities, including endoscopic clips, stents, vacuum-assisted closure, gap filling, and suturing devices, discussed their advantages and limitations when treating full-thickness gastrointestinal defects, and explored emerging innovations, including a novel endoluminal surgical platform for versatile suturing and a cell-laden scaffold for effective gap filling. Although these emerging technologies still require further pre-clinical and clinical trials to assess their feasibility and efficacy, the available modalities may be replaced and refined by these new techniques in the near future.

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    Zhong-Wei Wu, Chao-Hui Ding, Yao-Dong Song, Zong-Chao Cui, Xiu-Qian Bi, Bo Cheng
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    Puja Gaur Khaitan, Amber Famiglietti, Thomas J. Watson
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    Eleanor C. Fung
    Digestive Disease Interventions.2021; 05(02): 194.     CrossRef
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    Andrew Watson, Tobias Zuchelli
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    Vera Voinova, Garina Bonartseva, Anton Bonartsev
    World J Stem Cells.2019; 11(10): 764.     CrossRef
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    Jaehoon Cho, Ara B. Sahakian
    Gastrointestinal Endoscopy Clinics of North America.2018; 28(2): 233.     CrossRef
  • Non-visible colovesical fistula located by cystoscopy and successfully managed with the novel Padlock® device for endoscopic closure
    Benito Velayos, L. Del Olmo, L. Merino, M. Valsero, J. M. González
    International Journal of Colorectal Disease.2018; 33(6): 827.     CrossRef
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    A. P. Bonartsev, V. V. Voinova, G. A. Bonartseva
    Applied Biochemistry and Microbiology.2018; 54(6): 547.     CrossRef
  • Hepatocolic fistula managed with a novel Padlock® device for endoscopic closure
    Benito Velayos Jiménez, Lourdes Del Olmo Martínez, Carmen Alonso Martín, Javier Trueba Arguiñarena, José Manuel González Hernández
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    Tomasz Banasiewicz, Adam Dziki, Paweł Lampe, Zbigniew Lorenc, Marek Szczepkowski, Jacek Zieliński, Grzegorz Wallner
    Polish Journal of Surgery.2017; 89(2): 49.     CrossRef
  • 9,454 View
  • 189 Download
  • 11 Web of Science
  • 12 Crossref
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Recent Advanced Endoscopic Management of Endoscopic Retrograde Cholangiopancreatography Related Duodenal Perforations
Seon Mee Park
Clin Endosc 2016;49(4):376-382.   Published online July 29, 2016
DOI: https://doi.org/10.5946/ce.2016.088
AbstractAbstract PDFPubReaderePub
The management strategy for endoscopic retrograde cholangiopancreatography-related duodenal perforation can be determined based on the site and extent of injury, the patient’s condition, and time to diagnosis. Most cases of perivaterian or bile duct perforation can be managed with a biliary stent or nasobiliary drainage. Duodenal wall perforations had been treated with immediate surgical repair. However, with the development of endoscopic devices and techniques, endoscopic closure has been reported to be a safe and effective treatment that uses through-the-scope clips, ligation band, fibrin glue, endoclips and endoloops, an over-the-scope clipping device, suturing devices, covering luminal stents, and open-pore film drainage. Endoscopic therapy could be instituted in selected patients in whom perforation was identified early or during the procedure. Early diagnosis, proper conservative management, and effective endoscopic closure are required for favorable outcomes of non-surgical management. If endoscopic treatment fails, or in the cases of clinical deterioration, prompt surgical management should be considered.

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    Abdel Rahman A. A. Al Manasra, Zaid Mesmar, Tarek Manasreh, Hanan M . Hammouri, Anas Husein, Khaled Jadallah, Mohammed Bani hani, Niazy Abu Farsakh, Shatha K. Shahwan, Doaa Al-qaoud, Jehad Fataftah
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    Abdel Rahman A. A. Al Manasra, Zaid Mesmar, Tarek Manasreh, Hanan M . Hammouri, Anas Husein, Khaled Jadallah, Mohammed Bani hani, Niazy Abu Farsakh, Shatha K. Shahwan, Doaa Al-qaoud, Jehad Fataftah
    F1000Research.2023; 12: 612.     CrossRef
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    Osman Bozbiyik, Bartu Cetin, Tufan Gumus, Fatih Tekin, Alper Uguz
    BMC Gastroenterology.2022;[Epub]     CrossRef
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    Yin-Shui Miao, Yuan-Yuan Li, Bo-Wen Cheng, Yan-Fang Zhan, Sheng Zeng, Xiao-Jiang Zhou, You-Xiang Chen, Nong-Hua Lv, Guo-Hua Li
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    Jeffrey H. Lee, Prashant Kedia, Stavros N. Stavropoulos, David Carr-Locke
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    Akihisa OHNO, Nao FUJIMORI, Kazuhide MATSUMOTO, Katsuhito TERAMATSU, Yu TAKAMATSU, Masami MIKI, Takehiro TAKAOKA, Takamasa OONO
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    Nicole Evans, James L. Buxbaum
    Techniques in Gastrointestinal Endoscopy.2019; 21(2): 83.     CrossRef
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    Kan Wang, Jihao Shi, Linna Ye
    Laparoscopic, Endoscopic and Robotic Surgery.2019; 2(2): 41.     CrossRef
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    Amit Nehra, Rajesh Godara
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Case Report
Delayed Severe Hemobilia after Endoscopic Biliary Plastic Stent Insertion
Sung Hak Lee, Seung Goun Hong, Kyoung yong Lee, Pyung Kang Park, Sung Du Kim, Mahn Lee, Dong Wook Yu, Man Yong Hong
Clin Endosc 2016;49(3):303-307.   Published online March 25, 2016
DOI: https://doi.org/10.5946/ce.2015.081
AbstractAbstract PDFPubReaderePub
Hemobilia is a rare gastrointestinal bleeding, usually caused by injury to the bile duct. Hemobilia after endoscopic retrograde cholangiopancreatography (ERCP) is generally self-limiting and patients will spontaneously recover, but some severe and fatal hemorrhages have been reported. ERCP-related bowel or bile duct perforation should be managed promptly, according to the type of injury and the status of the patient. We recently experienced a case of late-onset severe hemobilia in which the patient recovered after endoscopic biliary stent insertion. The problem was attributable to ERCP-related bile duct perforation during stone removal, approximately 5 weeks prior to the hemorrhagic episode. The removal of the stent was performed 10 days before the onset of hemobilia. The bleeding was successfully treated by two sessions of transarterial coil embolization.

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  • A rare incidence of a hepatic artery pseudoaneurysm following plastic biliary stent insertion
    Toshihiko Motohara, Kensuke Yamamura, Shigenori Ueno, Hiroshi Takeno, Yasunori Nagayama, Eri Oda, Ryuichi Karashima, Nobuyuki Ozaki, Toshiro Masuda, Toru Beppu
    Clinical Journal of Gastroenterology.2024; 17(2): 352.     CrossRef
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    Ruchira Mukherji, Manoj Gopinath
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    Jinhyong Kang, Yang Tae Park, Hyo Jung Kim, Jae Seon Kim
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    Dinesh Manoharan, Deep Narayan Srivastava, Arun Kumar Gupta, Kumble Seetharama Madhusudhan
    Abdominal Radiology.2019; 44(6): 2205.     CrossRef
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    Kenji Yamauchi, Daisuke Uchida, Hironari Kato, Hiroyuki Okada
    Internal Medicine.2018; 57(1): 49.     CrossRef
  • Transcatheter arterial embolization for iatrogenic bleeding after endoscopic ultrasound-guided pancreaticobiliary drainage
    N.J. Lee, J.H. Shin, S.S. Lee, D.H. Park, S.K. Lee, H.-K. Yoon
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    Surendrakumar Mathur, Vinaykumar Thapar, Vasudev Chowda
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  • 9,338 View
  • 76 Download
  • 8 Web of Science
  • 7 Crossref
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Original Article
Optimal Methods for the Management of Iatrogenic Colonoscopic Perforation
Dae Kyu Shin, Sun Young Shin, Chi Young Park, Sun Mi Jin, Yang Hyun Cho, Won Hee Kim, Chang-Il Kwon, Kwang Hyun Ko, Ki Baik Hahm, Pil Won Park, Jong Woo Kim, Sung Pyo Hong
Clin Endosc 2016;49(3):282-288.   Published online February 18, 2016
DOI: https://doi.org/10.5946/ce.2015.046
AbstractAbstract PDFPubReaderePub
Background
/Aims: Colonoscopic perforations have been managed with exploratory laparotomy, and have resulted in some morbidity and mortality. Recently, laparoscopic surgery is commonly performed for this purpose. The aim of this study was to compare the outcomes of several management strategies for iatrogenic colonoscopic perforations.
Methods
We retrospectively reviewed the medical records of patients who had been treated for colonoscopic perforation between January 2004 and April 2013 at CHA Bundang Medical Center in Korea.
Results
A total of 41 patients with colonoscopic perforation were enrolled. Twenty patients underwent conservative management with a success rate of 90%. Surgical management was performed in 23 patients including two patients who were converted to surgical management after the failure of the initial conservative management. Among 14 patients who underwent surgery at 8 hours after the perforation, there was no considerable difference in adverse outcomes between the laparotomy group and the laparoscopic surgery group. The medical costs and claim rate were 1.45 and 1.87 times greater in the exploratory laparotomy group, respectively.
Conclusions
Conservative management of colonoscopic perforation could be an option for patients without overt symptoms of peritonitis or with a small defect size. If surgical management is required, laparoscopic surgery may be considered as the initial procedure even with a delayed diagnosis.

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Case Report
Unexpected Delayed Colon Perforation after the Endoscopic Submucosal Dissection with Snaring of a Laterally Spreading Tumor
Young Bo Ko, Jeong-Mi Lee, Wan Soo Kim, Min Seob Kwak, Ji Wan Lee, Dong Yeol Shin, Dong-Hoon Yang, Jeong-Sik Byeon
Clin Endosc 2015;48(6):570-575.   Published online November 30, 2015
DOI: https://doi.org/10.5946/ce.2015.48.6.570
AbstractAbstract PDFPubReaderePub
Colonic perforation may occur as a complication of diagnostic and therapeutic colonoscopy. The risk factors for perforation after colorectal endoscopic submucosal dissection (ESD) include an inexperienced endoscopist, a large tumor size, and submucosal fibrosis. The mechanisms of perforation include unintended endoscopic resection/dissection and severe thermal injury. Here, we report a case of colon perforation that occurred after ESD with snaring of a laterally spreading tumor. The perforation was completely unexpected because there were no colorectal ESD-associated risk factors for perforation, deep dissection, or severe coagulation injury in our patient.

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    World Journal of Clinical Cases.2020; 8(16): 3608.     CrossRef
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    Ning Cui, Yu Zhao, Honggang Yu
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    Kazumasa Kawashima, Takuto Hikichi, Tatsuo Fujiwara, Naohiko Gunji, Jun Nakamura, Ko Watanabe, Kyoko Katakura, Hiromasa Ohira
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Original Articles
Endoluminal Closure of Colon Perforation with Endoscopic Band Ligation: Technical Feasibility and Safety in an In Vivo Canine Model
Joung-Ho Han, Myounghwan Kim, Tae Hoon Lee, Hyun Kim, Yunho Jung, Seon Mee Park, Heebok Chae, Seijin Youn, Ji Yun Shin, In-Kwang Lee, Tae Soo Lee, Seok Hwa Choi
Clin Endosc 2015;48(6):534-541.   Published online November 30, 2015
DOI: https://doi.org/10.5946/ce.2015.48.6.534
AbstractAbstract PDFPubReaderePub
Background
/Aims: Endoscopic band ligation (EBL) is an accepted method in the management of variceal bleeding; however, there is little evidence on the safety and feasibility of EBL for the closure of bowel perforation. In this study, we aimed to evaluate the technical feasibility and efficacy of EBL in iatrogenic colon perforation by using a canine model.
Methods
We established an iatrogenic colon perforation model by using seven beagle dogs. Longitudinal 1.5- to 1.7-cm colon perforations were created with a needle knife and an insulated-tip knife, and the perforation was subsequently closed with EBL. During a 2-week follow-up period, the animals were carefully monitored and then euthanized for pathologic examination.
Results
The EBL of iatrogenic colon perforations was successful in all dogs. The mean procedure time for EBL closure with one to three bands was 191.7 seconds, and there were no immediate complications. One animal was euthanized after 3 days because of peritonitis. There were no clinical and laboratory features of sepsis or peritonitis in the remaining six animals. On necropsy, we did not find any fecal peritonitis, pericolonic abscess formation, or transmural dehiscence at the perforation site. Histopathology demonstrated inflamed granulation tissue and scar lesions replaced by fibrosis.
Conclusions
EBL might be a feasible and safe method for the management of iatrogenic colon perforations in an in vivo model.

Citations

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  • Endoscopic Management of Iatrogenic Colon Perforation
    Yunho Jung
    Clinical Endoscopy.2020; 53(1): 29.     CrossRef
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    Dae Hoon Kim, Hanlim Choi, Ki Bae Kim, Hyo Yung Yun, Joung-Ho Han
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    Kan Wang, Jihao Shi, Linna Ye
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    Yidong Yang, Xianyi Lin, Siwei Tan, Xiaoli Huang, Zijun Xie, Xuan Xu, Yiming Lei, Bin Wu
    Gastroenterology Research and Practice.2018; 2018: 1.     CrossRef
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Efficacy and Safety of Endoscopic Papillary Balloon Dilation Using Cap-Fitted Forward-Viewing Endoscope in Patients Who Underwent Billroth II Gastrectomy
Jong Soon Jang, Seungho Lee, Hee Seung Lee, Myeong Ho Yeon, Joung-Ho Han, Soon Man Yoon, Hee Bok Chae, Sei Jin Youn, Seon Mee Park
Clin Endosc 2015;48(5):421-427.   Published online September 30, 2015
DOI: https://doi.org/10.5946/ce.2015.48.5.421
AbstractAbstract PDFPubReaderePub
Background/Aims

Endoscopic exploration of the common bile duct (CBD) is difficult and dangerous in patients with Billroth II gastrectomy (B-II). Endoscopic papillary balloon dilation (EPBD) via a cap-fitted forward-viewing endoscope has been reported to be an effective and safe procedure. We analyzed the technical success and complications of EPBD in patients who underwent B-II.

Methods

Thirty-six consecutive patients with B-II were enrolled from among 2,378 patients who had undergone endoscopic retrograde cholangiopancreatography in a single institute in the last 4 years. The EPBD procedure was carried out using a cap-fitted forward-viewing endoscope with 8-mm balloon catheters for 60 seconds. We analyzed the rates of CBD exploration, technical success, and complications.

Results

Afferent loop intubation was performed in all patients and selective cannulation of the bile duct was performed in 32 patients (88.9%). Complications such as transient hypoxia were observed in two patients (5.6%) and perforation, in three patients (9.7%). The perforation sites were ductal injury in two patients and one patient showed retroperitoneal air alone without symptoms. Three patients manifested different clinical courses of severe acute pancreatitis and peritonitis, transient abdominal pain, and retroperitoneal air alone. The condition of one patient improved with surgery and that of the other two patients, with conservative management.

Conclusions

Patients with perforation during EPBD in B-II showed different clinical courses. Tailored treatment strategies are necessary for improving the clinical outcomes.

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    Kook Hyun Kim, Sung Bum Kim, Tae Nyeun Kim
    Clinical Endoscopy.2021; 54(1): 139.     CrossRef
  • Which scope is appropriate for endoscopic retrograde cholangiopancreatography after Billroth II reconstruction: An esophagogastroduodenoscope or a colonoscope?
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    Tae Young Park, Tae Jun Song
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    Rabbinu Rangga Pribadi, Abdul Aziz Rani, Murdani Abdullah
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    Murad Aburajab, Kulwinder Dua
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    Min-Gui Han, Eunae Cho, Chang-Hwan Park, Chung-Hwan Jun, Seon-Young Park
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    Seon Mee Park
    Clinical Endoscopy.2016; 49(4): 376.     CrossRef
  • 8,954 View
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Case Reports
Delayed Perforation Occurring after Endoscopic Submucosal Dissection for Early Gastric Cancer
Soo Hoon Kang, Kyungho Lee, Hyun Woo Lee, Ga Eun Park, Yun Soo Hong, Byung-Hoon Min
Clin Endosc 2015;48(3):251-255.   Published online May 29, 2015
DOI: https://doi.org/10.5946/ce.2015.48.3.251
AbstractAbstract PDFPubReaderePub

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.

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  • Delayed Perforation Occurring after Gastric Endoscopic Submucosal Dissection: Clinical Features and Management Strategy
    Tae-Se Kim, Byung-Hoon Min, Yang Won Min, Hyuk Lee, Poong-Lyul Rhee, Jae J. Kim, Jun Haeng Lee
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    Chan Hyuk Park, Dong-Hoon Yang, Jong Wook Kim, Jie-Hyun Kim, Ji Hyun Kim, Yang Won Min, Si Hyung Lee, Jung Ho Bae, Hyunsoo Chung, Kee Don Choi, Jun Chul Park, Hyuk Lee, Min-Seob Kwak, Bun Kim, Hyun Jung Lee, Hye Seung Lee, Miyoung Choi, Dong-Ah Park, Jong
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    Ga Hee Kim, Hwoon-Yong Jung
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    Chan Hyuk Park, Dong-Hoon Yang, Jong Wook Kim, Jie-Hyun Kim, Ji Hyun Kim, Yang Won Min, Si Hyung Lee, Jung Ho Bae, Hyunsoo Chung, Kee Don Choi, Jun Chul Park, Hyuk Lee, Min-Seob Kwak, Bun Kim, Hyun Jung Lee, Hye Seung Lee, Miyoung Choi, Dong-Ah Park, Jong
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    Chan Hyuk Park, Dong-Hoon Yang, Jong Wook Kim, Jie-Hyun Kim, Ji Hyun Kim, Yang Won Min, Si Hyung Lee, Jung Ho Bae, Hyunsoo Chung, Kee Don Choi, Jun Chul Park, Hyuk Lee, Min-Seob Kwak, Bun Kim, Hyun Jung Lee, Hye Seung Lee, Miyoung Choi, Dong-Ah Park, Jong
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    Chan Hyuk Park, Dong-Hoon Yang, Jong Wook Kim, Jie-Hyun Kim, Ji Hyun Kim, Yang Won Min, Si Hyung Lee, Jung Ho Bae, Hyunsoo Chung, Kee Don Choi, Jun Chul Park, Hyuk Lee, Min-Seob Kwak, Bun Kim, Hyun Jung Lee, Hye Seung Lee, Miyoung Choi, Dong-Ah Park, Jong
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    Satoru Homma, Kazuaki Tokodai, Minami Watanabe, Kai Takaya, Eiji Hashizume
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  • Clinical Factors of Delayed Perforation after Endoscopic Submucosal Dissection for Gastric Neoplasms
    Yoshinobu Yamamoto, Hogara Nishisaki, Hideki Sakai, Nagahiro Tokuyama, Hiroaki Sawai, Aya Sakai, Takuya Mimura, Saeko Kushida, Hidetaka Tsumura, Takeshi Sakamoto, Ikuya Miki, Masahiro Tsuda, Hideto Inokuchi
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    Haruhisa Suzuki
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Esophgeal Perforation and Bilateral Empyema Following Endoscopic EsophyX Transoral Incisionless Fundoplication
Hawa Edriss, Amal El-Bakush, Kenneth Nugent
Clin Endosc 2014;47(6):560-563.   Published online November 30, 2014
DOI: https://doi.org/10.5946/ce.2014.47.6.560
AbstractAbstract PDFPubReaderePub

Transoral incisionless fundoplication (TIF) has been used for endoscopic treatment of gastroesophageal reflux disease (GERD). TIF using the EsophyX device system (EndoGastric Solutions) was designed to create a full-thickness valve at the gastroesophageal junction through the insertion of multiple fasteners; it improves GERD, reduces proton pump inhibitor use, and improves quality of life. Although TIF is effective in select patients, a significant subset of patients undergoing TIF develop persistent or recurrent GERD symptoms and may need antireflux surgery to control the GERD symptoms. We now report a 48-year-old man with chronic GERD unresponsive to medical management. He underwent TIF complicated by esophageal perforation and developed mediastinitis, left pneumothorax, bilateral pleural effusions, and acute respiratory failure. He required chest tube placement and bilateral decortication for treatment of nonresolving empyemas. Additional postmarketing studies are required to assess the safety, efficacy, and clinical outcomes of this novel procedure, and patients undergoing this procedure need close postprocedural follow-up.

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  • Efficacy and patient satisfaction of single-session transoral incisionless fundoplication and laparoscopic hernia repair
    Catherine Gisi, Kelly Wang, Farhaad Khan, Sonya Reicher, Linda Hou, Clark Fuller, James Sattler, Viktor Eysselein
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    Colin G. DeLong, Joshua S. Winder
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    Robert A. Ganz, Steven A. Edmundowicz, Paul A. Taiganides, John C. Lipham, C. Daniel Smith, Kenneth R. DeVault, Santiago Horgan, Garth Jacobsen, James D. Luketich, Christopher C. Smith, Steven C. Schlack-Haerer, Shanu N. Kothari, Christy M. Dunst, Thomas
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Original Article
Gastric Endoscopic Submucosal Dissection Is Safe for Day Patients
Sun Young Ahn, Sun Ik Jang, Dong Wook Lee, Seong Woo Jeon
Clin Endosc 2014;47(6):538-543.   Published online November 30, 2014
DOI: https://doi.org/10.5946/ce.2014.47.6.538
AbstractAbstract PDFPubReaderePub
Background/Aims

Although the advantages of endoscopic submucosal dissection (ESD) are well established, there are important limitations that relate to its higher cost and higher rate of complications compared with endoscopic mucosal resection. This study assessed the therapeutic safety and efficacy of ESD in the treatment of small gastric dysplasia and early gastric cancer (EGC) located within the antrum in an outpatient setting, and it compared the results with those from patients admitted to hospital for ESD treatment.

Methods

This study was a retrospective analysis of a prospectively maintained database. We reviewed consecutive patients with EGC or gastric dysplasia who underwent ESD between October 2007 and May 2008. The lesions were smaller than 2 cm and were located in the antrum. We analyzed 105 lesions in 105 patients. The patients were assigned to two groups according to each patient's preference.

Results

The overall rates of complete resection were 98.1% in the inpatients group and 94.3% in the outpatients group. Immediate bleeding occurred in four inpatients, which included one patient in the outpatient group. Delayed bleeding occurred in one inpatient within 24 hours of the procedure. Macroperforations did not occur in either group. A microperforation was found in one outpatient.

Conclusions

The safety and efficacy of ESD used to treat small gastric tumors in the antrum in an outpatient setting appeared to be similar to the safety and efficacy of ESD used to treat patients who were admitted to the hospital.

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    Tetsuo Ushiku, Gregory Y. Lauwers
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    Renma Ito, Kazuhiro Miwa, Yutaka Matano
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    Diogo Libânio, Mariana Nuno Costa, Pedro Pimentel-Nunes, Mário Dinis-Ribeiro
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    Namrata Setia, Gregory Y. Lauwers
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    Hwoon-Yong Jung, Ji Yong Ahn
    Clinical Endoscopy.2014; 47(6): 473.     CrossRef
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