Department of Internal Medicine, Digestive Disease Center, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-ro Hwayang-dong, Gwangjin-gu, Seoul 143-729, Korea.
Surg Endosc. 2013 Feb;27(2):487-93. doi: 10.1007/s00464-012-2462-6. Epub 2012 Jul 18.
Endoscopic submucosal dissection (ESD) for colorectal neoplasms is not widely performed because of the high risk of perforation. Perforations are divided into macroperforations and microperforations. Currently, there is a limited amount of clinical data on the outcome of patients with these types of perforations during colonic ESD. The aim of this study was to investigate the clinical outcome of patients who sustained colon perforations during ESD. We also compared the clinical outcome of patients with microperforations and those with macroperforations.
This study enrolled 101 patients with colorectal laterally spreading tumors (LST) who underwent ESD. We retrospectively reviewed their medical records, including patient demographic data and the clinical, endoscopic, and pathologic features. In the cases where perforation had occurred, the course of hospital treatment was analyzed. All ESD-related perforations were divided into macroperforations and microperforations. A macroperforation was defined as a gross perforation that occurred during an ESD procedure and a microperforation was defined by free air visible on X-rays after the procedure.
Of the 101 enrolled patients, 9 (8.9 %) developed perforations. The most common tumor morphology was nongranular-type LST (5 of 9 cases, 55.6 %) based on endoscopic examination. Five patients had microperforations and four had macroperforations. All macroperforations were closed primarily by endoclips during ESD. The endoscopic characteristics did not differ between the groups. However, the length of hospital stay and the mean duration of NPO and antibiotic treatments were longer for microperforation patients. All patients had conservative nonsurgical management such as fasting, intravenous antibiotics, and nasogastric tube drainage.
The clinical complications for microperforation patients were worse than those for macroperforation patients. However, the clinical prognoses of patients with perforations that occur during colonic ESD are favorable.
由于穿孔风险较高，内镜黏膜下剥离术（ESD）在结直肠肿瘤中的应用并不广泛。穿孔分为大穿孔和小穿孔。目前，关于结肠 ESD 过程中发生这些类型穿孔的患者的临床结局的临床数据有限。本研究旨在探讨 ESD 过程中发生结肠穿孔患者的临床结局。我们还比较了小穿孔和大穿孔患者的临床结局。
本研究纳入了 101 例接受结直肠侧向扩展肿瘤（LST）ESD 的患者。我们回顾性分析了他们的病历，包括患者的人口统计学数据以及临床、内镜和病理特征。在发生穿孔的病例中，分析了住院治疗的过程。所有 ESD 相关穿孔均分为大穿孔和小穿孔。大穿孔定义为 ESD 过程中发生的明显穿孔，小穿孔定义为术后 X 射线可见自由空气。
在纳入的 101 例患者中，有 9 例（8.9%）发生穿孔。根据内镜检查，最常见的肿瘤形态为非颗粒型 LST（5/9 例，55.6%）。5 例患者发生小穿孔，4 例发生大穿孔。所有大穿孔在 ESD 过程中均通过内镜夹直接闭合。两组的内镜特征无差异。然而，小穿孔患者的住院时间、无饮食时间和抗生素治疗时间均较长。所有患者均接受了保守的非手术治疗，如禁食、静脉使用抗生素和鼻胃管引流。
小穿孔患者的临床并发症比大穿孔患者更严重。然而，结肠 ESD 过程中发生穿孔的患者的临床预后良好。
