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Management of bleeding and artificial gastric ulcers associated with endoscopic submucosal dissection

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Author(s): Yosuke Muraki | Shotaro Enomoto | Mikitaka Iguchi | Mitsuhiro Fujishiro | Naohisa Yahagi | Masao Ichinose

Journal: World Journal of Gastrointestinal Endoscopy
ISSN 1948-5190

Volume: 4;
Issue: 1;
Start page: 1;
Date: 2012;
Original page

Keywords: Artificial ulcer | Endoscopic hemostasis | Endoscopic submucosal dissection | Gastric epithelial neoplasia | Hemostatic forceps

ABSTRACT
Endoscopic submucosal dissection (ESD), an endoscopic procedure for the treatment of gastric epithelial neoplasia without lymph node metastases, spread rapidly, primarily in Japan, starting in the late 1990s. ESD enables en bloc resection of lesions that are difficult to resect using conventional endoscopic mucosal resection (EMR). However, in comparison to EMR, ESD requires a high level of endoscopic competence and a longer resection time. Thus, ESD is associated with a higher risk of adverse events, including intraoperative and postoperative bleeding and gastrointestinal perforation. In particular, because of a higher incidence of intraoperative bleeding with mucosal incision and submucosal dissection, which are distinctive endoscopic procedures in ESD, a strategy for endoscopic hemostasis, mainly by thermo-coagulation hemostasis using hemostatic forceps, is important. In addition, because of iatrogenic artificial ulcers that always form after ESD, endoscopic hemostasis and appropriate pharmacotherapy during the healing process are essential.
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