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Delayed perforation: A hazardous complication of endoscopic resection for non‐ampullary duodenal neoplasm
Author(s) -
Inoue Takuya,
Uedo Noriya,
Yamashina Takeshi,
Yamamoto Sachiko,
Hanaoka Noboru,
Takeuchi Yoji,
Higashino Koji,
Ishihara Ryu,
Iishi Hiroyasu,
Tatsuta Masaharu,
Takahashi Hidenori,
Eguchi Hidetoshi,
Ohigashi Hiroaki
Publication year - 2014
Publication title -
digestive endoscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.5
H-Index - 56
eISSN - 1443-1661
pISSN - 0915-5635
DOI - 10.1111/den.12104
Subject(s) - medicine , perforation , surgery , complication , ampulla of vater , endoscopic mucosal resection , retrospective cohort study , whipple procedure , endoscopy , ampulla , therapeutic endoscopy , duodenal cancer , duodenum , resection , pancreaticoduodenectomy , carcinoma , materials science , punching , metallurgy
Background Perforation 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 Methods This 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 J anuary 1993 to D ecember 2011. Incidence, outcome, and factors associated with occurrence of delayed perforation were investigated. Results Delayed perforation occurred in four patients (6.3%). All lesions were located distal to V ater's ampulla. Three of four delayed perforations occurred within 36 h 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 V ater's ampulla, P = 0.007) and resection method ( ESD and piecemeal EMR , P = 0.003). Conclusion Endoscopic 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 .