Gweon Tae-Geun, Yang Dong-Hoon
Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Clin Endosc. 2023 Jul;56(4):423-432. doi: 10.5946/ce.2023.104. Epub 2023 Jul 27.
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.
与内镜黏膜切除术（EMR）相比，结肠镜下内镜黏膜下剥离术（C-ESD）具有更高的整块切除率和更低的结直肠肿瘤复发率。因此，C-ESD被认为是治疗侧向扩散肿瘤和早期结直肠癌的有效方法。然而，C-ESD在技术上更具难度，且与EMR相比需要更长的手术时间。在临床实践中进行C-ESD时，除了治疗效果和手术难度外，还应始终考虑安全性问题。出血和穿孔是与C-ESD相关的主要不良事件，可发生在C-ESD过程中或手术完成后。与C-ESD相关的大多数出血可通过内镜处理，即使其发生在手术期间或术后。最近，C-ESD过程中发现的大多数穿孔也可通过内镜处理，除非壁缺损太大无法用内镜设备缝合或患者血流动力学不稳定。延迟穿孔相当罕见，但与内镜下发现的术中穿孔或放射学检查发现的术后即刻穿孔相比，它们更常需要手术治疗。ESD后凝血综合征是一种相对被低估的不良事件，可类似于穿孔引起的局限性腹膜炎。在此，我们对与C-ESD相关的并发症进行分类和特征描述，并推荐针对这些并发症的处理方法。
