Complications of Gastric Endoscopic Submucosal Dissection

Endoscopic resection is now a widely accepted treatment for early gastric cancer, having a negligible risk of lymph-node metastasis. Endoscopic submucosal dissection (ESD) is a relatively new endoscopic resection method developed in the mid-1990s that facilitates en-bloc resection even in patients with large or ulcerative lesions difficult to resect using conventional endoscopic mucosal resection (EMR). However, compared to EMR, ESD requires a longer procedure time and a higher level of technical expertise, in addition to having a slightly greater risk of complications. Endoscopists must be aware of not only the risk factors for, and incidence of, complications, but also how to effectively treat such complications. Perforation and bleeding are the major complications associated with gastric ESD. The perforation and delayed bleeding rates have been reported to range from 1.2% to 5.2% and 0% to 15.6%, respectively, and can usually be managed with appropriate endoscopic treatment. Immediate bleeding during gastric ESD is quite common and controlling such bleeding, which is primarily achieved by carrying out electrocautery, plays a critical role in the successful completion of ESD.