Department of Gastroenterology, Gifu University Hospital, Gifu, Japan.
Endoscopy. 2010 Jun;42(6):441-7. doi: 10.1055/s-0029-1244013. Epub 2010 Apr 29.
A small amount of free air, visible on CT but not on plain chest radiography, which appeared following endoscopic submucosal dissection (ESD) of a gastric neoplasm without endoscopically visible perforation, was defined as a "transmural air leak", and a prospective, consecutive entry study was performed to determine its incidence and clinical significance.
Between January 2006 and September 2008, ESD was performed for 246 gastric lesions in 246 consecutive patients. Abdominal CT scan was performed 1 day after ESD. In addition, chest radiography and blood biochemistry tests were performed at different time points before and after ESD.
Two hundred and nineteen lesions (89 %) were curatively removed by ESD. Among the total of 246 patients, we encountered endoscopically visible perforation during ESD in 2 patients (0.8 %), and clinically suspected perforation diagnosed by the presence of free air on chest radiography but invisible during ESD in 3 patients (1 %), while transmural air leak was observed in another 33 (13 %). Air leak occurred in cases where resection size was larger, procedure time longer, and the muscularis propria on the ulcer base was exposed at the end of ESD. Patients with air leaks developed pyrexia at a higher rate than those without (36 % vs. 16 %, P = 0.018). These patients recovered with antibiotics and required no endoscopic or surgical intervention. The presence of an air leak did not affect the duration of hospital stay.
A transmural air leak was observed in 13 % of the patients undergoing ESD. Larger resection size, prolonged procedure time, and exposure of the muscularis propria on the ulcer base were risk factors for transmural air leak, but the outcome of patients with this complication was good.
内镜黏膜下剥离术（ESD）治疗胃肿瘤后，即使在直视下未见穿孔，CT 上仍可见少量游离气体，我们将其定义为“贯穿性气漏”。本研究旨在前瞻性连续纳入病例，以明确其发生率和临床意义。
2006 年 1 月至 2008 年 9 月，246 例连续患者接受了 246 例胃肿瘤的 ESD 治疗。ESD 后第 1 天行腹部 CT 扫描。另外，在 ESD 前后不同时间点行胸部 X 线和血液生化检查。
246 例患者中，219 例（89%）病变整块切除。2 例（0.8%）术中发现内镜下可见穿孔，3 例（1%）术后胸部 X 线见游离气体而 ESD 未见穿孔，诊断为临床可疑穿孔，另 33 例（13%）出现贯穿性气漏。气漏与切除范围较大、操作时间较长以及 ESD 结束时溃疡底部固有肌层暴露有关。气漏组发热发生率高于无气漏组（36% vs. 16%，P=0.018），但经抗生素治疗后恢复，无需内镜或外科干预。气漏并未影响患者住院时间。
13%的 ESD 患者出现贯穿性气漏。较大的切除范围、较长的操作时间以及溃疡底部固有肌层暴露是发生贯穿性气漏的危险因素，但该并发症患者的预后良好。
