结直肠内镜黏膜下剥离术后迟发性穿孔的强化内镜干预的安全性和可行性（附视频）

Safety and feasibility of intensive endoscopic interventions for delayed perforation after colorectal endoscopic submucosal dissection (with video).

作者信息

Shichijo Satoki, Takeuchi Yoji, Kitagawa Daiki, Ohkubo Yuki, Kawakami Yushi, Tani Yasuhiro, Tsukuda Nobutoshi, Matsuyama Kazuki, Ito Noriaki, Fujimoto Yuta, Tanabe Gentaro, Ando Yoshiaki, Ninomiya Takehiro, Kizawa Atsuko, Ueda Tomoya, Asada Yuya, Kato Minoru, Yoshii Shunsuke, Maekawa Akira, Kanesaka Takashi, Higashino Koji, Uedo Noriya, Ishihara Ryu, Michida Tomoki, Nishimura Junichi, Yasui Masayoshi, Ohue Masayuki

机构信息

Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan.

出版信息

Gastrointest Endosc. 2025 Apr 8. doi: 10.1016/j.gie.2025.03.1328.

DOI:10.1016/j.gie.2025.03.1328

PMID:40210010

Abstract

BACKGROUND AND AIMS

Colorectal endoscopic submucosal dissection (ESD) is widely performed for large superficial colorectal tumors; however, it can lead to adverse events such as delayed perforation, which may require emergency surgery. Our goal was to elucidate the clinical course of delayed perforation and the safety and feasibility of intensive endoscopic interventions.

METHODS

Patients diagnosed with delayed perforation after colorectal ESD between February 2011 and April 2023 were retrospectively analyzed. Delayed perforation was defined as follows: no perforation during ESD; abdominal pain and fever after ESD; and extraluminal gas identified during CT imaging.

RESULTS

ESD was performed for 1763 patients with 1845 lesions (right-sided colon, 1018; left-sided colon, 827). Thirty-three delayed perforations (27 between 2011 and 2020; 6 between 2021 and 2023) occurred. Muscle injury occurred during ESD in 4 patients. The ESD ulcer was closed in 6 patients. CT imaging was performed when abdominal pain with fever (n = 17), abdominal pain (n = 13), fever (n = 2), and fatigue (n = 1) were observed. The median period between ESD and CT imaging was 22 hours (IQR, 8-41.25 hours). Seven patients required emergency surgery between 2011 and 2020; of these patients, 5 underwent surgery within 6 hours after CT imaging and 2 required surgery after conservative treatment. Endoscopy was performed for 5 of 6 patients between 2021 and 2023. Endoscopic intervention and successful conservative treatment were performed after identification of the perforation.

CONCLUSIONS

Intensive endoscopic interventions for delayed perforation after ESD may prevent emergency surgery.

摘要

背景与目的

大肠内镜黏膜下剥离术（ESD）广泛应用于治疗大型浅表性结直肠肿瘤；然而，该手术可能导致诸如延迟穿孔等不良事件，这可能需要进行急诊手术。我们的目标是阐明延迟穿孔的临床过程以及强化内镜干预的安全性和可行性。

方法

对2011年2月至2023年4月期间在大肠ESD术后被诊断为延迟穿孔的患者进行回顾性分析。延迟穿孔的定义如下：ESD术中未发生穿孔；ESD术后出现腹痛和发热；CT成像显示腔外气体。

结果

对1763例患者的1845个病变进行了ESD（右半结肠，1018个；左半结肠，827个）。发生了33例延迟穿孔（2011年至2020年期间27例；2021年至2023年期间6例）。4例患者在ESD术中发生肌肉损伤。6例患者的ESD溃疡得以闭合。在观察到发热伴腹痛（n = 17）、腹痛（n = 13）、发热（n = 2）和乏力（n = 1）时进行了CT成像检查。ESD与CT成像之间的中位时间为22小时（IQR，8 - 41.25小时）。2011年至2020年期间有7例患者需要急诊手术；其中，5例患者在CT成像后6小时内接受了手术，2例患者在保守治疗后需要手术。2021年至2023年期间，6例患者中的5例接受了内镜检查。在确认穿孔后进行了内镜干预并成功进行了保守治疗。