Complications in ESD for Early Esophageal Carcinoma Manabu Takeuchi 1 , Masaaki Kobayashi 2 , Tsuneo Oyama 3 , Akito Sato 2 , Satoru Hashimoto 2 , Yuichi Sato 2 , Rintaro Narisawa 1 , Yutaka Aoyagi 2 1Department of Endoscopy, Niigata University Medical and Dental Hospital, Niigata, Japan 2Department of Gastroenterology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan 3Department of Gastroenterology, Saku Central Hospital, Nagano, Japan Keyword: ESD , 食道 , 偶発症 , 穿孔 pp.384-393
Published Date 2009/3/25
DOI https://doi.org/10.11477/mf.1403101607
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 The Complications in esophageal endoscopic submucosal dissection(ESD) are perforation, bleeding, mediastinal emphysema and aspiration pneumonia, and in these complications, perforations possibly become the most serious condition because of mediastinal abscess. Intraoperative bleeding disturbs the good fields during ESD and causes damage of the proper muscle or perforation, so it is essential to stop the bleeding immediately or prevent bleeding efficiently. Because the esophageal wall is very thin and has no serosa, exposure and damage of the circular muscle possibly leads to perforation and mediastintis. The key point in preventing perforation is to visually recognize the submucosal layer and the proper muscle before dissecting. Most intraoperative perforations by ESD are very small and can be closed endoscopically using a clipping method. However, because of the risk of secondary enlargement in the perforation using endclips, careful clipping procedures are needed. If we damage the esophageal circular muscle during ESD, we shouldn't permit the patient to ingest food for several days to prevent delayed perforation.

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