Clinical course of patients after perforation associated with endoscopic submucosal dissection for colorectal neoplasms

Abstract

[Background] Although various methods have been used to make colorectal ESD a less invasive procedure, perforation sometimes occurs. [Purpose] The purpose of this study was to examine the clinical course of patients with colorectal ESD perforation in our hospital. [Subjects/methods] Of the 1780 colorectal lesions resected by ESD in our hospital from April 2005 to December 2019, 40 lesions in 40 cases with perforation were retrospectively examined. RESULTS: Of the 40 cases with perforation, intraoperative perforation was found in 29 cases (1.7%), and delayed perforation was found in 11 cases (0.6%). Out of 29 cases with intraoperative perforation, 25 cases were able to complete the excision of lesions, and 4 cases were interrupted with surgical operation performed on another day. Abdominal findings were aggravated in 3 of the 25 patients who received conservative treatment, and emergency surgery was performed. In 11 cases with delayed perforation, 5 cases were diagnosed on the 1st and 2nd days after surgery, and 1 case was diagnosed on the 5th day. Of the 11 cases, emergency surgery was necessary in 5 cases, which was a high rate compared with intraoperative perforation. [Conclusion] Compared with intraoperative perforation, delayed perforation often requires emergency surgery. The prevention of delayed perforation is a future issue.