| Theme |
Complications and their Managements for Gastrointestinal Endoscopy |
| Title |
Gastric Iatrogenic Perforation and its Management in Endoscopic Mucosal Resection |
| Author |
Taiji Akamatsu |
Departmeut of Endoscopy, Shinshu University Hospital |
| Author |
Naoshi Nakamura |
The Second Department of Internal Medicine, Shinshu University School of Medicine |
| Author |
TMasahiro Matsuzawa |
Departmeut of Endoscopy, Shinshu University Hospital |
| Author |
Taro Mochizuki |
The Second Department of Internal Medicine, Shinshu University School of Medicine |
| Author |
Akihiro Shinji |
The Second Department of Internal Medicine, Shinshu University School of Medicine |
| Author |
Kendo Kiyosawa |
The Second Department of Internal Medicine, Shinshu University School of Medicine |
| [ Summary ] |
Six cases of gastric iatrogenic perforation in endoscopic mucosal resection (EMR) were studied. Gastric perforations were caused by ensnarement of the proper muscular layer in 3 out of 4 cases that were complicated by strip biopsy procedures. It is important to inject adequate quantities of physiological saline between the lesion and the proper muscular layer to prevent gastric perforations. On the other hand, gastric perforations during EMR, using an IT knife and endoscopic scraping enucleation, occurred because of technical errors. The lesions, in all cases except one, were in the U region. The gastric wall in the U regionis thinner compared with that in other regions, therefore, EMR in the U region should be performed more carefully. Three out of 6 cases were treated with conservative therapies, such as inserting a nasogastric tube, fasting, and giving antibiotics as well as gastric acid suppressors intravenously. All three cases were cured. Endoscopic repair, using a clipping device, seemed to reduce the number of complaints and the period of admission. Two of the remaining 3 cases were performed using surgical treatment with local gastric resection because of residue from the lesion. Many gastric iatrogenic perforations are thought to be cured by using appropriate, conservative therapy, but careful follow up is necessary during conservative therapy. Endoscopic repair, using a clipping device is useful to treat for iatrogenic perforation in EMR. |