Delayed perforation: A hazardous complication of endoscopic resection for non- ampullary duodenal neoplasm
Delayed perforation: A hazardous complication of endoscopic resection for non- ampullary duodenal neoplasm
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DOI：
10.1111/den.12104
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发表时间：
2014-03-01
影响因子：
5.3
通讯作者：
Ohigashi, Hiroaki
中科院分区：
文献类型：
--
作者：
Inoue, Takuya;Uedo, Noriya;Ohigashi, Hiroaki
穿孔是内镜下消化道肿瘤切除术的主要并发症。然而，对非壶腹十二指肠肿瘤内镜切除术后延迟穿孔知之甚少。本研究的目的是探讨内镜切除术后延迟穿孔的临床特点为non-ampulary duodenal neoplasms.Patients and MethodsThis是一项回顾性队列研究在转诊癌症中心进行。从1993年1月至2011年12月，共63例患者（41例腺瘤和22例癌）接受了内镜粘膜切除术（EMR）或内镜粘膜下剥离术（ESD）。发病率，结果，并与发生延迟穿孔的相关因素进行了调查。ResultsDelayed穿孔发生在4例（6.3%）。所有病变均位于乏特壶腹远端。4例延迟穿孔中有3例发生在内镜切除术后36小时内。所有患者均发生腹膜后炎，2例还发生腹膜后脓肿。虽然3例患者通过保守治疗治愈，但需要长时间住院（分别为28天、80天和81天）。1例患者因全腹膜炎需要紧急手术。幸运的是，在这个系列中没有死亡。延迟穿孔的显著预测因素是位置（远端乏特氏壶腹，P=0.007）和切除方法（ESD和零碎EMR，P=0.003）。结论内镜下切除非壶腹十二指肠肿瘤有可能发生并发症，即延迟穿孔的风险，特别是在病变位于壶腹远端一侧的患者中，并接受零碎EMR或ESD治疗。
BackgroundPerforation is a major complication of endoscopic resection for gastrointestinal neoplasms. However, little is known about delayed perforation after endoscopic resection for non-ampullary duodenal neoplasm. The aim of the present study was to investigate the clinical features of delayed perforation after endoscopic resection for non-ampullary duodenal neoplasm.Patients and MethodsThis was a retrospective cohort study conducted in a referral cancer center. A total of 63 patients (41 with adenomas and 22 with carcinomas) underwent endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) from January 1993 to December 2011. Incidence, outcome, and factors associated with occurrence of delayed perforation were investigated.ResultsDelayed perforation occurred in four patients (6.3%). All lesions were located distal to Vater's ampulla. Three of four delayed perforations occurred within 36h after endoscopic resection. All patients developed retroperitonitis, and two also had retroperitoneal abscesses. Although three patients were cured with conservative management, a long hospital stay was required (28-, 80-, and 81-day hospital stay, respectively). One patient required emergency surgery as a result of panperitonitis. There was, fortunately, no mortality in this series. The significant predictors of delayed perforation were location (distal to Vater's ampulla, P=0.007) and resection method (ESD and piecemeal EMR, P=0.003).ConclusionEndoscopic resection for non-ampullary duodenal neoplasms has a possible risk of morbid complication i.e. delayed perforation, especially in patients with lesions located on the side distal from the ampulla and who are treated with piecemeal EMR or ESD.