| Theme |
Risk Management in Colonoscopy |
| Title |
Risk Management in Polypectomy, EMR and ESD |
| Author |
Hiroshi Kashida |
Department of Gastroenterology and Hepatology, Kinki University Faculty of Medicine |
| Author |
Yoriaki Komeda |
Department of Gastroenterology and Hepatology, Kinki University Faculty of Medicine |
| Author |
Toshiharu Sakurai |
Department of Gastroenterology and Hepatology, Kinki University Faculty of Medicine |
| Author |
Yutaka Asakuma |
Department of Gastroenterology and Hepatology, Kinki University Faculty of Medicine |
| Author |
Hiromasa Mine |
Department of Gastroenterology and Hepatology, Kinki University Faculty of Medicine |
| Author |
Teppei Adachi |
Department of Gastroenterology and Hepatology, Kinki University Faculty of Medicine |
| [ Summary ] |
Complications associated with endoscopic treatments for colorectal neoplasia include bleeding and perforation, each of which is categorized as onsite or delayed. Delayed bleeding is defined as overt bleeding that is associated with a ≥2 g/dl decrease in hemoglobin, or that requires blood transfusion or endoscopic hemostasis. In patients receiving antithrombotic therapy, the guidelines published by medical societies should be referred to. In a pedunculated polyp, an endoloop can prevent onsite and delayed bleeding. Onsite perforation may occur when the muscle layer is involved within the snare during endoscopic mucosal resection (EMR), or when the electrical spark is directed to the muscle layer during endoscopic submucosal dissection (ESD). In the lower rectum or in the posterior wall of the ascending or descending colon, injury to the muscle layer directly leads to perforation, as such areas are not covered by a serosal membrane. Cold polypectomy is considered to be associated with lower risk of perforation and delayed bleeding in cases with small polyps. Closure with clips will not prevent delayed bleeding in mucosal defects after EMR or ESD, except in patients with large lesions or those receiving anti?thrombotic therapy, but should be effective for preventing delayed perforation in high?risk conditions. |