Clin Endosc.  2023 Jul;56(4):409-422. 10.5946/ce.2023.024.

Complications of endoscopic resection in the upper gastrointestinal tract

• Uozumi T
• Abe S
• Makiguchi ME
• Nonaka S
• Suzuki H
• Yoshinaga S
• Saito Y

• KMID: 2544562
• DOI: http://doi.org/10.5946/ce.2023.024

Abstract

Endoscopic resection (ER) is widely utilized as a minimally invasive treatment for upper gastrointestinal tumors; however, complications could occur during and after the procedure. Post-ER mucosal defect leads to delayed perforation and bleeding; therefore, endoscopic closure methods (endoscopic hand-suturing, the endoloop and endoclip closure method, and over-the-scope clip method) and tissue shielding methods (polyglycolic acid sheets and fibrin glue) are developed to prevent these complications. During duodenal ER, complete closure of the mucosal defect significantly reduces delayed bleeding and should be performed. An extensive mucosal defect that comprises three-quarters of the circumference in the esophagus, gastric antrum, or cardia is a significant risk factor for post-ER stricture. Steroid therapy is considered the first-line option for the prevention of esophageal stricture, but its efficacy for gastric stricture remains unclear. Methods for the prevention and management of ER-related complications in the esophagus, stomach, and duodenum differ according to the organ; therefore, endoscopists should be familiar with ways of preventing and managing organ-specific complications.

Keyword

Complications; Endoscopic mucosal resection; Endoscopic resection; Esophageal stricture

Figure

• 

  Fig. 1. Tissue shielding method with polyglycolic acid sheet and fibrin glue. (A) A 15-mm type 0–IIc lesion was located in the lesser curvature of the pyloric ring. (B) Endoscopic submucosal dissection (ESD) was performed, and en bloc resection was achieved. (C) Polyglycolic acid sheet and fibrin glue were attached to the post-ESD ulcer. (D) Postoperative day (POD) 5. (E) POD 15. (F) POD 60. There were no adverse events after the ESD.

• 

  Fig. 2. Endoloop and endoclip closure method. (A) A 12-mm type 0–IIa lesion was located in the second part of the duodenum. (B) Endoscopic mucosal resection was performed, and en bloc resection was achieved. (C) The endoloop was anchored to the distal side of the mucosal defect. (D) The endloop was placed with the endoclips along the edge of the mucosal defect. (E) The mucosal defect was closed by tightening the fixed endoloop. (F) Complete closure was successfully achieved.

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