| Theme |
Perforation and it's Management in Endoscopy |
| Title |
Prevention and Management of Perforations in Endoscopic Therapy for Early Esophageal Cancer |
| Author |
Manabu Takeuchi |
Department of Endoscopy, Niigata University Hospital |
| Author |
Masaaki Kobayashi |
Department of Gastroenterology, Niigata University Graduate School of Medical and Dental Sciences |
| Author |
Satoru Hashimoto |
Department of Endoscopy, Niigata University Hospital |
| Author |
Rintaro Narisawa |
Department of Gastroenterology, Niigata University Graduate School of Medical and Dental Sciences |
| Author |
Yutaka Aoyagi |
Department of Gastroenterology, Niigata University Graduate School of Medical and Dental Sciences |
| [ Summary ] |
Means to prevent perforations during esophageal endoscopic mucosal resection (EMR) are the snaring of the proper muscular layer and appropriate submucosal injection, re-snaring before cutting, taking care with suctioning, grasping, and snaring of the first resected site to prevent perforations. Injury to the proper muscle is a cause of perforations in endoscopic submucosal dissection (ESD). Marking and mucosal incision with precise use of the device, submucosal dissection with sodium hyaluronate injection into the submucosal layer and the ST-hood are all effective in preventing perforations. Adequate coagulation of the proper muscle where complications occur may delay or avoid perforation. Most intraoperative perforations due to ESD are very small and can be closed endoscopically using a clipping method. However, because of the risk of secondary enlargement of perforations when using endclips, careful clipping procedures are required. |