3356 An endoscopic rescue from perforation after endoscopic mucosal resection for early gastric cancer

Background. Endoscopic mucosal resection (EMR) has been employed for treatment of early gastric cancer (EGC) in the world, and especially in Japan from the beginning of the 1980s. It has an advantage over surgical gastrectomy in patient's quality of life. However, there is some possibility of complications, such as perforation of the gastric wall and active bleeding. Especially, up to now, a surgical operation has been required to treat perforation and it causes the deterioration of the patient's QOL. In this study, we introduce how to manage and rescue the patients from perforation after EMR without surgical treatment from our experience. Methods. We had 618 patients with 780 cancers or severe dysplasias. They received EMR from October 1987 to August 1999 at the National Cancer Center Hospital, Tokyo, Japan. From 1994, we tried to suture the holes of the stomach using clips endoscopically, with insertion of a nasogastric tube for one day. Results. Perforation occurred in 44 patients (7%). In the early period from 1987 to 1993, all 4 patients with perforation underwent surgical treatment. Of the 40 patients with endoscopic sutures, 39 patients (97.5%) except for one patient, who had a perforation hole of more than 40 mm in size, succeeded in recovering without surgical treatment. Conclusions. Our data suggest that endoscopic suture using clips is a good procedure to rescue from perforation after EMR.