Gastric Endoscopic submucosal disssection(ESD): Complications
The major complication of ESD is bleeding. The amount of intraoperative bleeding that can be divided into intraoperative bleeding and postoperative bleeding was determined by post-op because it was difficult to accurately measure during the procedure. In one of the articles, the bleeding was expressed as significant intraoperative bleeding when Hb decreased more than 2g / The ratio is about 7%. Less bleeding occurs at a higher rate. To prevent intraoperative bleeding, it is important to clearly visualize the endoscopic view through sufficient submucosal injection, coagulate visible blood vessels, and cut the deep submucosal layer to a suitable depth. If bleeding occurs, use a water jet to quickly locate the bleeding site. The bleeding risk varies depending on the site. Compared to antrum, the middle and upper third of the body have a vascular rich submucosal layer, which is highly likely to cause bleeding. Post-op bleeding is known to occur at 5.3 to 15.6%. PPI is known to be effective in preventing post-op bleeding and should be used for 2 weeks after ESD.
Another complication is perforation. Intraoperative perforation is present in 1.2 ~ 8.2% of the cases. During the endoscopic procedure, fat and external organs can be seen through the muscle layer or free air is seen in the xray after surgery. However, there is no perforation or peritonitis, We need to distinguish silent free air when air is visible. Silent free air is found in 37% after ESD and silent free air is known to not cause any special complication. In order to prevent perforation, it is advisable to inject enough hyaluronic acid solution into the submucosal layer and to sedate the patient sufficiently. There is no need to stop ESD if perforation has occurred, close the defect with an endoclip, administer antibiotics and complete the ESD. Post-op perforation is very rare and usually occurs within 1-2 days after the procedure, occurring at about 0.45%. If post-op perforation occurs, immediate surgery is important.
Aspiration pneumonia may occur during ESD. Patients are often treated in the left lateral decubitus position, so they usually occur in the left lung. To prevent this, enough suction is needed to remove the saliva. To prevent vomiting, excessive air insufflation is not recommended.
Stenosis occurs after ESD, which means that the standard endoscope can not pass through. It occurs in the range of 0.9 ~ 1.9% and it occurs well when the operation is performed around cardia and pylorus. Endoscopic balloon dilation is recommended if stenosis is present, and surgical treatment if endoscopic procedures are difficult.
Another complication is perforation. Intraoperative perforation is present in 1.2 ~ 8.2% of the cases. During the endoscopic procedure, fat and external organs can be seen through the muscle layer or free air is seen in the xray after surgery. However, there is no perforation or peritonitis, We need to distinguish silent free air when air is visible. Silent free air is found in 37% after ESD and silent free air is known to not cause any special complication. In order to prevent perforation, it is advisable to inject enough hyaluronic acid solution into the submucosal layer and to sedate the patient sufficiently. There is no need to stop ESD if perforation has occurred, close the defect with an endoclip, administer antibiotics and complete the ESD. Post-op perforation is very rare and usually occurs within 1-2 days after the procedure, occurring at about 0.45%. If post-op perforation occurs, immediate surgery is important.
Aspiration pneumonia may occur during ESD. Patients are often treated in the left lateral decubitus position, so they usually occur in the left lung. To prevent this, enough suction is needed to remove the saliva. To prevent vomiting, excessive air insufflation is not recommended.
Stenosis occurs after ESD, which means that the standard endoscope can not pass through. It occurs in the range of 0.9 ~ 1.9% and it occurs well when the operation is performed around cardia and pylorus. Endoscopic balloon dilation is recommended if stenosis is present, and surgical treatment if endoscopic procedures are difficult.
