TY - JOUR
T1 - Bleeding after endoscopic submucosal dissection
T2 - Risk factors and preventive methods
AU - Kataoka, Yosuke
AU - Tsuji, Yosuke
AU - Sakaguchi, Yoshiki
AU - Minatsuki, Chihiro
AU - Asada-Hirayama, Itsuko
AU - Niimi, Keiko
AU - Ono, Satoshi
AU - Kodashima, Shinya
AU - Yamamichi, Nobutake
AU - Fujishiro, Mitsuhiro
AU - Koike, Kazuhiko
N1 - Publisher Copyright:
© The Author(s) 2016.
PY - 2016/7/14
Y1 - 2016/7/14
N2 - Endoscopic submucosal dissection (ESD) has become widely accepted as a standard method of treatment for superficial gastrointestinal neoplasms because it enables en block resection even for large lesions or fibrotic lesions with minimal invasiveness, and decreases the local recurrence rate. Moreover, specimens resected in an en block fashion enable accurate histological assessment. Taking these factors into consideration, ESD seems to be more advantageous than conventional endoscopic mucosal resection (EMR), but the associated risks of perioperative adverse events are higher than in EMR. Bleeding after ESD is the most frequent among these adverse events. Although post-ESD bleeding can be controlled by endoscopic hemostasis in most cases, it may lead to serious conditions including hemorrhagic shock. Even with preventive methods including administration of acid secretion inhibitors and preventive hemostasis, post-ESD bleeding cannot be completely prevented. In addition high-risk cases for post-ESD bleeding, which include cases with the use of antithrombotic agents or which require large resection, are increasing. Although there have been many reports about associated risk factors and methods of preventing post-ESD bleeding, many issues remain unsolved. Therefore, in this review, we have overviewed risk factors and methods of preventing post-ESD bleeding from previous studies. Endoscopists should have sufficient knowledge of these risk factors and preventive methods when performing ESD.
AB - Endoscopic submucosal dissection (ESD) has become widely accepted as a standard method of treatment for superficial gastrointestinal neoplasms because it enables en block resection even for large lesions or fibrotic lesions with minimal invasiveness, and decreases the local recurrence rate. Moreover, specimens resected in an en block fashion enable accurate histological assessment. Taking these factors into consideration, ESD seems to be more advantageous than conventional endoscopic mucosal resection (EMR), but the associated risks of perioperative adverse events are higher than in EMR. Bleeding after ESD is the most frequent among these adverse events. Although post-ESD bleeding can be controlled by endoscopic hemostasis in most cases, it may lead to serious conditions including hemorrhagic shock. Even with preventive methods including administration of acid secretion inhibitors and preventive hemostasis, post-ESD bleeding cannot be completely prevented. In addition high-risk cases for post-ESD bleeding, which include cases with the use of antithrombotic agents or which require large resection, are increasing. Although there have been many reports about associated risk factors and methods of preventing post-ESD bleeding, many issues remain unsolved. Therefore, in this review, we have overviewed risk factors and methods of preventing post-ESD bleeding from previous studies. Endoscopists should have sufficient knowledge of these risk factors and preventive methods when performing ESD.
KW - Antithrombotic agents
KW - Bleeding
KW - Endoscopic submucosal dissection
KW - Prevention
KW - Risk factor
UR - http://www.scopus.com/inward/record.url?scp=84978237220&partnerID=8YFLogxK
U2 - 10.3748/wjg.v22.i26.5927
DO - 10.3748/wjg.v22.i26.5927
M3 - 記事
C2 - 27468187
AN - SCOPUS:84978237220
SN - 1007-9327
VL - 22
SP - 5927
EP - 5935
JO - World Journal of Gastroenterology
JF - World Journal of Gastroenterology
IS - 26
ER -