Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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Two Cases of Aspiration Pneumonia after Endoscopic Submucosal Dissection

내시경 점막하 박리술 후에 발생한 흡인성 폐렴 2예

  • Choi, Ji-Young (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Do-Hoon (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Ahn, Ji-Yong (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Park, Hyun-Joo (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Yun, Gui-Jun (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Young-Saeng (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Jung, Hwoon-Yong (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Jin-Ho (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine)
  • 최지영 (울산대학교 의과대학 서울아산병원 내과학교실) ;
  • 김도훈 (울산대학교 의과대학 서울아산병원 내과학교실) ;
  • 안지용 (울산대학교 의과대학 서울아산병원 내과학교실) ;
  • 박현주 (울산대학교 의과대학 서울아산병원 내과학교실) ;
  • 윤귀준 (울산대학교 의과대학 서울아산병원 내과학교실) ;
  • 김영생 (울산대학교 의과대학 서울아산병원 내과학교실) ;
  • 정훈용 (울산대학교 의과대학 서울아산병원 내과학교실) ;
  • 김진호 (울산대학교 의과대학 서울아산병원 내과학교실)
  • Published : 2011.05.30
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Abstract

The greatest advantage of endoscopic submucosal dissection (ESD) in the stomach is that it can be used to perform en bloc resection of a large gastric neoplasm. However, ESD is more technically difficult and more commonly associated with prolonged procedure time and complications than conventional endoscopic mucosal resection. Until now, only a few reports have considered aspiration pneumonia after ESD, which is rare, but can be fatal. We experienced two cases of aspiration pneumonia after ESD with a gastric neoplasm. One was treated by intensive care with mechanical ventilation, and the other by antibiotics only. Prevention is thought to be important for aspiration pneumonia after ESD; therefore, patients at high risk for aspiration pneumonia are urged to take precautions. We considered various factors contributing to aspiration under endoscopy, such as local pharyngeal anesthesia, procedural time, and bleeding.

내시경 점막하 박리술은 크거나 궤양이 있는 병변에 대한 일괄 절제를 가능하게 하지만, 시술 시간이 더 길고 합병증의 위험이 더 높다. 내시경 점막하 박리술 후 발생하는 흡인성 폐렴은 드문 합병증이지만, 때로는 치명적일 수 있다. 저자들은 내시경 점막하 박리술 후 발생한 폐렴으로 기계환기가 필요했던 1예와 일반적인 예방적 투여만으로 회복되었던 1예를 경험하였다. 내시경 점막하 박리술 후 발생하는 흡인성 폐렴은 예방이 중요할 것으로 판단되며, 인두 마취, 시술시간, 출혈 등 여러요인들이 기여할 수 있으므로 흡인성 폐렴의 위험군에서는 이에 대한 각별한 주의가 필요하겠다.

Keywords

References

  1. Kim BJ, Chang TH, Kim JJ, et al. Efficacy and safety of endoscopic submucosal dissection for early gastric cancer in patients with comorbid diseases. Gut Liver 2010;4:186-191. https://doi.org/10.5009/gnl.2010.4.2.186
  2. Hotta K, Oyama T, Akamatsu T, et al. A comparison of outcomes of endoscopic submucosal dissection (ESD) for early gastric neoplasms between high-volume and low-volume centers: multi-center retrospective questionnaire study conducted by the Nagano ESD Study Group. Intern Med 2010;49:253-259. https://doi.org/10.2169/internalmedicine.49.2816
  3. Jang JS, Choi SR, Qureshi W, et al. Long-term outcomes of endoscopic submucosal dissection in gastric neoplastic lesions at a single institution in South Korea. Scand J Gastroenterol 2009;44:1315-1322. https://doi.org/10.3109/00365520903254304
  4. Chung IK, Lee JH, Lee SH, et al. Therapeutic outcomes in 1,000 cases of endoscopic submucosal dissection for early gastric neoplasms: Korean ESD Study Group multicenter study. Gastrointest Endosc 2009;69:1228-1235. https://doi.org/10.1016/j.gie.2008.09.027
  5. Isomoto H, Ohnita K, Yamaguchi N, et al. Clinical outcomes of endoscopic submucosal dissection in elderly patients with early gastric cancer. Eur J Gastroenterol Hepatol 2010;22:311-317. https://doi.org/10.1097/MEG.0b013e32832c61d7
  6. Hoteya S, Iizuka T, Kikuchi D, Yahagi N. Clinical advantages of endoscopic submucosal dissection for gastric cancers in remnant stomach surpass conventional endoscopic mucosal resection. Dig Endosc 2010;22:17-20. https://doi.org/10.1111/j.1443-1661.2009.00912.x
  7. Shimura T, Sasaki M, Kataoka H, et al. Advantages of endoscopic submucosal dissection over conventional endoscopic mucosal resection. J Gastroenterol Hepatol 2007;22:821-826. https://doi.org/10.1111/j.1440-1746.2006.04505.x
  8. Prout BJ, Metreweli C. Pulmonary aspiration after fibre-endoscopy of the upper gastrointestinal tract. Br Med J 1972;4:269-271. https://doi.org/10.1136/bmj.4.5835.269
  9. Thomson A, Tye-Din J, Tonga S, et al. Aspiration in the context of upper gastrointestinal endoscopy. Can J Gastroenterol 2007;21:223-225. https://doi.org/10.1155/2007/307937
  10. Taylor PA, Cotton PB, Towey RM, Gent AE. Pulmonary complications after oesophagogastroscopy using diazepam. Br Med J 1972;1:666. https://doi.org/10.1136/bmj.1.5801.666
  11. Healy TE, Vickers MD. Laryngeal competence under diazepam sedation. Proc R Soc Med 1971;64:85-86.
  12. Lee IL, Wu CS, Tung SY, et al. Endoscopic submucosal dissection for early gastric cancers: experience from a new endoscopic center in Taiwan. J Clin Gastroenterol 2008;42:42-47. https://doi.org/10.1097/01.mcg.0000225696.54498.ff
  13. Lee TH, Hsueh PR, Yeh WC, Wang HP, Wang TH, Lin JT. Low frequency of bacteremia after endoscopic mucosal resection. Gastrointest Endosc 2000;52:223-225. https://doi.org/10.1067/mge.2000.107718