Korean J Gastrointest Endosc > Volume 37(2); 2008 > Article
Korean Journal of Gastrointestinal Endoscopy 2008;37(2): 97-104.
내시경 점막 절제술 및 내시경 점막하 박리술 시행 중 발생한 위장천공의 비수술적 치료
계명대학교 의과대학 내과학교실, *동국대학교 의과대학 마취통증의학교실
Nonsurgical Treatment of Gastric Perforation Complicated by Endoscopic Mucosal Resection and Endoscopic Submucosal Dissection
Seok Guen Lee, M.D., Kwang Bum Cho, M.D., Yoon Suk Hong, M.D., Hyun Woong Lee, M.D., Jung Min Lee, M.D., Byoung Kuk Jang, M.D., Woo Jin Chung, M.D., Kyung Sik Park, M.D., Jae Seok Hwang, M.D. and Eun Jee Park, M.D.*
Department of Internal Medicine, Keimyung University College of Medicine, Daegu, *Department of Anesthesiology and Pain Medicine, Dongguk University College of Medicine, Gyeongju, Korea

Endoscopic Mucosal Resection (EMR) and Endoscopic Submucosal Dissection (ESD) are novel techniques used for the treatment of early gastric cancer and precancerous lesions of the stomach. However, complications such as bleeding and perforation may occur during the procedure, and these complications may raise the morbidity and mortality rates. EMR/ESD-induced perforations can be treated with conservative medical or non-surgical methods. Furthermore, an increasing number of reports have addressed conservative management of EMR/ESD-induced perforations. We evaluated the effectiveness and safety of implementing conservative treatment for perforations associated with EMR and ESD.
We reviewed 482 patients with 507 lesions who underwent EMR or ESD due to early gastric cancers or gastric adenomas between February 2003 and December 2007. We identified 14 perforations occurring as complications of EMR/ESD and investigated their clinical outcomes.
Fourteen perforations (14/507 [2.8%]) occurred, 11 of which were immediately clipped during the procedure, and 3 of which were diagnosed after the procedure when free air was visualized on the radiograph. All patients were managed conservatively with fluid resuscitation and antibiotics (mean, 5.8 days). They recovered without surgery and were discharged in stable condition at a mean of 7.2 days post-procedure.
Endoscopic clip application might be an effective and safe option for conservative management of EMR/ESD-induced perforations. (Korean J Gastrointest Endosc 2008;37:97-104)
Key Words: Perforation, Conservative management, Endoscopic submucosal dissection
주요어: 천공, 비수술적 치료, 내시경 점막하 박리술
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