A Case of Acute Myocardial Infarction Occurred Immediately after Endoscopic Submucosal Dissection / 대한소화기학회지

Endoscopic methods such as endoscopic mucosal resection or endoscopic submucosal dissection (ESD) have been increasingly used for the treatment of gastric adenoma and early gastric cancer. Especially, ESD is very useful since it allows en bloc resection of large lesions. Bleeding and perforation are well known as common complications after ESD. However, there is no report of acute myocardial infarction associated with ESD. We report a case of acute myocardial infarction which was detected immediately after ESD.

Nonsurgical Treatment of Gastric Perforation Complicated by Endoscopic Mucosal Resection and Endoscopic Submucosal Dissection / 대한소화기내시경학회지

BACKGROUND/AIMS: Endoscopic Mucosal Resection (EMR) and Endoscopic Submucosal Dissection (ESD) are novel techniques used for the treatment of early gastric cancer and precancerous lesions of the stomach. However, complications such as bleeding and perforation may occur during the procedure, and these complications may raise the morbidity and mortality rates. EMR/ESD-induced perforations can be treated with conservative medical or non-surgical methods. Furthermore, an increasing number of reports have addressed conservative management of EMR/ESD-induced perforations. We evaluated the effectiveness and safety of implementing conservative treatment for perforations associated with EMR and ESD. METHODS: We reviewed 482 patients with 507 lesions who underwent EMR or ESD due to early gastric cancers or gastric adenomas between February 2003 and December 2007. We identified 14 perforations occurring as complications of EMR/ESD and investigated their clinical outcomes. RESULTS: Fourteen perforations (14/507 [2.8%]) occurred, 11 of which were immediately clipped during the procedure, and 3 of which were diagnosed after the procedure when free air was visualized on the radiograph. All patients were managed conservatively with fluid resuscitation and antibiotics (mean, 5.8 days). They recovered without surgery and were discharged in stable condition at a mean of 7.2 days post-procedure. CONCLUSIONS: Endoscopic clip application might be an effective and safe option for conservative management of EMR/ESD-induced perforations.