[Rectal perforation after endoscopic submucosal dissection: conservative management]. / Perforación de recto post-disección endoscópica de la submucosa: Tratamiento conservador.

Endoscopic mucosal resection and surgery have been the treatments used for resection of early neoplastic colorectal lesions. However, since a few years ago the endoscopic submucosal dissection is a procedure accepted for the curative treatment of these lesions. Among the complications that can occur with this procedure, perforation is one of the most serious ones, requiring in most cases surgical management. A case is reported of a sixty-year-old male patient diagnosed with an extensive flat colorectal polyp, who underwent an endoscopic submucosal dissection, with the subsequent complications of a perforation with subcutaneous emphysema and extra peritoneal air. In conjunction with the surgical team, a decision was made to apply a conservative medical treatment based on suspension of the oral intake and antibiotic therapy, yielding good clinical and imaging evolution.

Gastric endoscopic submucosal dissection: from animal model to patient.

AIM: To assess whether the use of porcine models is useful for learning endoscopic submucosal dissection (ESD), thus contributing to its subsequent application in human patients. METHODS: This study/learning process was carried out in 3 phases: Phase I: Ex vivo animal; Phase II: In vivo animal; Phase III: Humans. One endoscopist performed 30 gastric ESDs in porcine models, and later 5 gastric ESDs in 5 patients. The ESD was done following the method practiced at the National Cancer Center in Tokyo, Japan. Technical aspects, size, time and speed of ESD, as well as complications were registered. In patients, their clinical, endoscopic and histologic evolution was additionally added. RESULTS: Thirty en bloc ESDs were carried out in animal models. The mean ± SD size of the pieces was of 28.4 ± 1.2 mm, and the time of ESD was 41.7 ± 2.4 min. The time of ESD in the first 15 procedures was 43.0 ± 3.0 min whereas in the next 15 procedures, the time was 40.3 ± 3.9 min, P = 0.588. The speed in the first 15 ESDs was 1.25 ± 0.11 cm(2)/min vs 2.12 ± 0.36 cm(2)/min in the remaining 15, P = 0.028. There were no complications. In patients, 5 lesions were resected en bloc. The size of the pieces was 25.2 ± 5.1 mm and the time was 85.0 ± 25.6 min. Endoscopic and histological controls did not show evidence of residual neoplastic tissue. CONCLUSION: A sequential ESD training program of a unique endoscopist, based on the practice in porcine models, contributed to learning ESD for its subsequent application in humans, yielding good results in efficacy and safety.