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Case series of intra-abdominal adhesions induced by artificial ulceration after endoscopic submucosal dissection before additional laparoscopic gastrectomy.

Abstract：

BACKGROUND:As endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) increases, increasing numbers of patients require additional gastrectomy with lymph node dissection after noncurative ESD. ESD may cause intra-abdominal adhesions, making additional laparoscopic gastrectomy technically difficult. OBJECTIVE:To assess the relation of the presence of intra-abdominal adhesions and ESD treatment to allow safe laparoscopic gastrectomy. DESIGN:Case series from a retrospective review of additional gastrectomy after noncurative ESD. SETTING:Tertiary care center. PATIENTS AND INTERVENTIONS:Eight of 333 patients receiving ESD at Oita University Faculty of Medicine from 1999 to 2008 underwent additional laparoscopic gastrectomy because of noncurative ESD. MAIN OUTCOME MEASUREMENTS:Intra-abdominal adhesions were evaluated by using an adhesion scoring system (0-3 points) and clinicopathologic findings, including artificial ulcerations after ESD. RESULTS:All patients successfully underwent laparoscopic gastrectomy within 1 to 2 months after ESD. Three patients with large artificial ulceration (>25 mm) after ESD treatment had severe intra-abdominal adhesions (adhesion score > or =2). These patients tended to have a large blood loss and long operation times during laparoscopic gastrectomy. Despite the 2-month interval from ESD to laparoscopic gastrectomy, ulcerations in these patients were at healing stage with inflammatory cells infiltrating the muscular deep layer. LIMITATION:A retrospective study. CONCLUSIONS:After ESD with large artificial ulceration (>25 mm), the presence of intra-abdominal adhesions complicating additional laparoscopic gastrectomy was often observed.

journal_name

Gastrointest Endosc

journal_title

Gastrointestinal endoscopy

authors

Akagi T,Shiraishi N,Hiroishi K,Etoh T,Yasuda K,Kitano S

doi

10.1016/j.gie.2010.03.1066

subject

Has Abstract

pub_date

2010-08-01 00:00:00

pages

438-43

issue

eissn

0016-5107

issn

1097-6779

pii

S0016-5107(10)01343-X

journal_volume

pub_type

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Case series of intra-abdominal adhesions induced by artificial ulceration after endoscopic submucosal dissection before additional laparoscopic gastrectomy.