1. Asan Medical Center Choi Ji Young
ESD complication
박상훈
Asan Medical Center
Choi Ji Young

2. Present Illness 1st 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

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

4. Initial Lab Data CBC 7800 /mm3 - 14.1 g/dL - 335 K /mm3
AST/ALT 23/30 IU/L ALP 63 IU/L
TB/DB 0.7/0.2 mg/dL
Protein 7.3 g/dL Albumin g/dL
Electrolyte – 4.0 – 102 mEq/L
BUN 11 mg/dL Cr mg/dL
PT % (0.95 INR) aPTT sec

5. Initial CXR

6. EGD

8. Post ESD S) Fever with chills, cough, rhinorrhea (POD#0)
O) BP 126/82 HR 100 RR 24 BT 38.6℃

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

10. Post ESD
POD #4
POD #12

11. Present Illness 2nd 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

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

13. Initial Lab Data CBC 8100 /mm3 - 14.5 g/dL - 145K /mm3
AST/ALT 27/30 IU/L ALP 48 IU/L
TB/DB 0.9/- mg/dL
Protein 6.5 g/dL Albumin g/dL
Electrolyte – 4.5 – 103 mEq/L
BUN 15 mg/dL Cr mg/dL
PT % (1.17 INR) aPTT sec

14. Initial CXR

15. Initial EGD
Bx : tubular adenoma

17. Post ESD S) dyspnea, chest pain
O) BP 120/70 HR 79 RR 22 BT 38.9℃ SpO2 90%
POD #0
POD #1

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

19. Post ESD
Pneumococci-urine Ag test : positive

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

21. Brief review
Post ESD - pneumonia

22. ESD complication - 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:
Lee et al. J Clin Gastroenterol 2008; 42: 42-47

23. ESD complication - pneumonia
Aspiration is another problem because ESD is a time-consuming 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: