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The Current Status and Management of Complications from Gastric ESD―Safety Procedures and the Importance of the Depth of Dissection Takashi Toyonaga 1 , Eisei Nishino 2 , Takashi Hirooka 1 1Department of Gastroenterology, Kishiwada Tokushukai Hospital 2Department of Pathology, Kishiwada Tokushukai Hospital Keyword: ESD , 偶発症対策 , 凝固モードトリミング , 剝離深度 , 内側縦斜走筋群 pp.75-85
Published Date 2006/1/25
DOI https://doi.org/10.11477/mf.1403100022
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 The main complications due to ESD are bleeding and perforation. Both of these have intra-operative and post-operative delayed consequences. Intra-operative perforation can be readily and conservatively treated by clipping, which is performed leaving sufficient space to enable subsequent treatment. Intra-operative bleeding can affect the efficiency and consequence of ESD. Blood vessels of the submucosal layer which account for bleeding are distributed broadly into 3 regions : the antrum, the lesser curvature of the stomach and the anterior and posterior wall of the stomach (area of distribution of the medial longitudinal oblique muscle), so the setting of the procedure and the depth of dissection according to regions are key points. In the case of using the IT knife, the field of view is maintained by an attachment and combined dissection by Forced or Swift coagulation (coagulation mode trimming) has enabled the reduction of bleeding. It is considered that delayed perforation is due to coagulation necrosis of whole layers due to over stimulation by electric current. It requires surgical treatment because the muscle layer which is extensive in area comes off. We must pay careful attention to dilatation of post-operative stenosis because it may adhere and cause perforation. Post-operative bleeding occurs frequently in the regions of the antrum and the lesser curvature of the stomach and it is related strongly to occupied regions.


Copyright © 2006, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院

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