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World J Gastrointest Endosc. Jan 16, 2012; 4(1): 1-8
Published online Jan 16, 2012. doi: 10.4253/wjge.v4.i1.1
Management of bleeding and artificial gastric ulcers associated with endoscopic submucosal dissection
Yosuke Muraki, Shotaro Enomoto, Mikitaka Iguchi, Mitsuhiro Fujishiro, Naohisa Yahagi, Masao Ichinose
Yosuke Muraki, Shotaro Enomoto, Mikitaka Iguchi, Masao Ichinose, Second Department of Internal Medicine, Wakayama Medical University, Wakayama-city, Wakayama 641-0012, Japan
Mitsuhiro Fujishiro, Department of Endoscopy and Endoscopic Surgery, Faculty of Medicine, University of Tokyo, Bunkyo-ku, Tokyo 113-8655, Japan
Naohisa Yahagi, Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Shinjuku-ku, Tokyo 160-8582, Japan
Author contributions: Muraki Y and Enomoto S contributed equally to this work; Muraki Y drafted the manuscript; Enomoto S made preparations for this manuscript; Iguchi M, Fujishiro M, Yahagi N and Ichinose M performed critical revision; all authors read and approved the final manuscript.
Supported by A Grant-in-Aid for Cancer Research from the Ministry of Health, Labor and Welfare of Japan, in part
Correspondence to: Shotaro Enomoto, MD, PhD, Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama-city, Wakayama 641-0012, Japan. shoe@orion.ocn.ne.jp
Telephone: +81-73-4471335 Fax: +81-73-4453616
Received: July 6, 2011
Revised: November 6, 2011
Accepted: January 12, 2012
Published online: January 16, 2012

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.

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