ESD complication Asan Medical Center Choi Ji Young

ESD complication Asan Medical Center Choi Ji Young

Present Illness 1 st case • 57/M • 건강 검진 EGD상 EGC 진단받고 본원으로 전원됨. • Endoscopic resection 위해서 입원. Past Medical History DM HTN Social History Alcohol : social drinker (매주 소주 1잔) Smoking : 10 pyrs, ex-smoker Family History N/S

Review of System General weight loss(-) Physical Examination General healthy-looking appearance alert mental status Respiratory cough/sputum/rhinorrhea(-) dyspena(-) Respiratory clear breathing sound without crackle and wheezing Gastrointestinal dyspepsia(-) soft and flat anorexia/nausea/vomiting(-/tenderness/RT (-/-)

Initial Lab Data CBC 7800 /mm 3 - 14. 1 g/d. L - 335 K /mm 3 AST/ALT 23/30 IU/L ALP 63 IU/L TB/DB 0. 7/0. 2 mg/d. L Protein 7. 3 g/d. L Albumin 4. 4 g/d. L Electrolyte 141 – 4. 0 – 102 m. Eq/L BUN 11 mg/d. L Cr 1. 0 mg/d. L PT 115. 8 % (0. 95 INR) a. PTT 27. 5 sec

Initial CXR

EGD

Post ESD S) Fever with chills, cough, rhinorrhea (POD#0) O) BP 126/82 HR 100 RR 24 BT 38. 6℃

Post ESD A) Post-ESD aspiration pneumonia P) Conservative management including antibiotics

Post ESD POD #4 POD #12

Present Illness 2 nd case • 73/M • Dyspepsia로 외부 병원에서 EGD 시행 후 gastric adenoma 진단받고 본원으로 전원됨. • Endoscopic resection 위해서 입원. Past Medical History HTN Social History Alcohol : heavy drinker (매일 소주 1병) Smoking : 50 pyrs Family History Mother – pancreatic cancer

Review of System General weight loss(-) Physical Examination General not so ill-looking appearance alert mental status Respiratory cough/sputum/rhinorrhea(-/- Respiratory /-) dyspnea(-) clear breathing sound without crackle and wheezing Gastrointestinal soft and flat dyspepsia(+) tenderness/RT (-/-) anorexia/nausea/vomiting(-//-)

Initial Lab Data CBC 8100 /mm 3 - 14. 5 g/d. L - 145 K /mm 3 AST/ALT 27/30 IU/L ALP 48 IU/L TB/DB 0. 9/- mg/d. L Protein 6. 5 g/d. L Albumin 3. 9 g/d. L Electrolyte 141 – 4. 5 – 103 m. Eq/L BUN 15 mg/d. L Cr 1. 2 mg/d. L PT 83. 4 % (1. 17 INR) a. PTT 28. 9 sec

Initial CXR

Initial EGD Bx : tubular adenoma

Post ESD S) dyspnea, chest pain O) BP 120/70 HR 79 RR 22 BT 38. 9℃ Sp. O 2 90% POD #0 POD #1

Post ESD A) r/o Post-ESD aspiration pneumonia r/o Community-acquired pneumonia P) Conservative management including antibiotics

Post ESD Pneumococci-urine Ag test : positive

POD #2 POD #8 POD #4 POD #6 POD #17 POD #24

Brief review Post ESD - pneumonia

ESD complication - pneumonia • Pneumonia – Possibly because of aspiration – Relatively rare complication • 0. 8 ~ 4% • More frequently in the elderly patients (0% vs 2. 2%) – All patients recoverd well with antibiotic treatment. Isomoto et al. Eur J Gastroenterol Hepatol 2010; 22: 311 -317 Lee et al. J Clin Gastroenterol 2008; 42: 42 -47

ESD complication - pneumonia – Aspiration is another problem because ESD is a timeconsuming procedure. • The risk of aspiration may increase if it is a long-term endoscopic procedure. – No clear whether the use of prophylactic antibiotics therapy is beneficial in such settings. – A low frequency of bacteremia has been reported after EMR -c. Lee et al. J Clin Gastroenterol 2008; 42: 42 -47 Lee et al. Gastrointes Endosc 2002; 52: 223 -225