World J Gastroenterol. 2010 Apr 14;16(14):1688-95. doi: 10.3748/wjg.v16.i14.1688.
Endoscopic submucosal dissection (ESD) is efficient for en bloc resection of large colorectal tumors. However, it has several technical difficulties, because the wall of the colon is thin and due to the winding nature of the colon. The main complications of ESD comprise postoperative perforation and hemorrhage, similar to endoscopic mucosal resection (EMR). In particular, the rate of perforation in ESD is higher than that in EMR. Perforation of the colon can cause fatal peritonitis. Endoscopic clipping is reported to be an efficient therapy for perforation. Most cases with perforation are treated conservatively without urgent surgical intervention. However, the rate of postoperative hemorrhage in ESD is similar to that in EMR. Endoscopic therapy including endoscopic clipping is performed and most of the cases are treated conservatively without blood transfusion. In blood examination, some degree of inflammation is detected after ESD. For the standardization of ESD, it is most important to decrease the rate of perforation. Adopting a safe strategy for ESD and a suitable choice of knife are both important ways of preventing perforation. Moreover, appropriate training and increasing experience can improve the endoscopic technique and can decrease the rate of perforation. In this review, we describe safe procedures in ESD to prevent complications, the complications of ESD and their management.
内镜黏膜下剥离术（ESD）对于整块切除大肠肿瘤是有效的。然而，它有几个技术难点，因为结肠壁较薄，而且由于结肠的蜿蜒性质。ESD 的主要并发症包括术后穿孔和出血，类似于内镜黏膜切除术（EMR）。特别是，ESD 穿孔的发生率高于 EMR。结肠穿孔可引起致命性腹膜炎。内镜夹闭被报道为穿孔的有效治疗方法。大多数穿孔病例都采用保守治疗而无需紧急手术干预。然而，ESD 术后出血的发生率与 EMR 相似。进行内镜治疗，包括内镜夹闭，大多数病例都采用保守治疗而无需输血。在血液检查中，ESD 后会检测到一定程度的炎症。为了规范 ESD，最重要的是降低穿孔率。采用安全的 ESD 策略和合适的刀具有助于预防穿孔。此外，适当的培训和经验的积累可以提高内镜技术，降低穿孔率。在这篇综述中，我们描述了预防并发症的 ESD 安全程序、ESD 的并发症及其处理。
