Original Article
Complete endoscopic closure of gastric perforation induced by endoscopic resection of early gastric cancer using endoclips can prevent surgery (with video)

https://doi.org/10.1016/j.gie.2005.07.029Get rights and content

Background

When gastric perforation occurs during endoscopic resection for early gastric cancer, a surgical treatment generally is performed. Considering the increasing number of EMRs and the possibility of perforation, our research sought to investigate whether endoscopic treatment for gastric perforation is possible.

Methods

From 1987 to 2004, 121 of 2460 patients who underwent gastric EMR at the National Cancer Center Hospital had gastric perforation during EMR (4.9%). The initial 4 patients were treated with emergent surgery. The subsequent 117 patients who were treated with endoclips formed our study population.

Results

Endoscopic closure with endoclips in 115 patients (98.3%) was successful. Two patients with unsuccessful endoscopic closure underwent emergent surgery. In the past 6 years, patients with perforation during gastric EMR treated with endoscopic closure had a recovery rate similar to that of the nonperforation cases.

Conclusions

Gastric perforation during endoscopic resection can be conservatively treated by complete endoscopic closure with endoclips.

Section snippets

Patients and methods

A total of 2460 patients with EGC underwent endoscopic resection at the National Cancer Center Hospital from 1987 to 2004. Gastric perforation occurred in 121 patients (4.9%) during the endoscopic procedures (101 men and 20 women; median age 67 years, range 36-84 years). Informed consent, which described the merits and the complications of gastric EMR or ESD, was routinely obtained from each patient before these procedures.

Two methods of endoscopic closure were carried out: a “single-closure

Results

The rate of gastric perforation for each study period is shown in Table 2. Among all cases with perforation, 30 cases had been treated by standard EMR procedures (30/566 [5.3%]) and 91 cases by the ESD procedure (91/1894 [4.8%]). There were no statistically significant differences in the perforation rate between standard EMR procedures and the ESD procedure.

There were no statistically significant differences in the perforation rates of tumor locations (upper third of the stomach 36/431 [8.4%];

Discussion

Because of technical limitation by standard EMR procedures in the past, an accepted indication for EMR of EGC included the resection of small intramucosal cancer less than 2 cm in size of intestinal histology type.13 These standard techniques cannot be used to resect lesions larger than 15 mm in one piece.14 Piecemeal resections can cause the pathologist to render pathologic staging with inadequate certainty, and there is a high risk of a recurrence after piecemeal resections.15, 16

However, by

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