| Theme |
Countermeasures of adverse events in therapeutic endoscopy |
| Title |
Management of the bleedings and perforations of colorectal endoscopic submucosal dissection |
| Author |
Hiroyuki Takamaru |
Endoscopy Division, National Cancer Center Hospital |
| Author |
Yutaka Saito |
Endoscopy Division, National Cancer Center Hospital |
| Author |
Masayoshi Yamada |
Endoscopy Division, National Cancer Center Hospital |
| Author |
Masau Sekiguchi |
Endoscopy Division, National Cancer Center Hospital / Screening Center, National Cancer Center Hospital |
| Author |
Taku Sakamoto |
Endoscopy Division, National Cancer Center Hospital |
| Author |
Takahisa Matsuda |
Endoscopy Division, National Cancer Center Hospital / Screening Center, National Cancer Center Hospital |
| [ Summary ] |
Endoscopic submucosal dissection (ESD) is a minimally invasive and effective treatment for early colonic neoplasms. Management of adverse event is crucial for colorectal ESD, because it may be possibly caused in a certain ratio. Precautionary approach is the principle rule for preventing both bleeding and perforation. Management of patients with anti-coagulative agents is one of the important aspects for management of bleeding during or after ESD. Endoscopic clipping closure seems to be effective for patient with perforation during procedure. Off course you should try to sac the fluids and residual stools following the adequate changing position of patients, when immediate perforation occurs. On the other hand, delayed bleeding may require emergency surgery, so assessment of patients after ESD is critical. You should share the information of patient with surgeons, especially the patients with high risk for perforation. It stands to reason that you should make patients understand by your thorough explanations. |