Complete endoscopic closure of gastric perforation induced by endoscopic resection of early gastric cancer using endoclips can prevent surgery (with video)

BACKGROUND: When gastric perforation occurs during endoscopic resection for early gastric cancer, a surgical treatment generally is performed. Considering the increasing number of EMRs and the possibility of perforation, our research sought to investigate whether endoscopic treatment for gastric perforation is possible. METHODS: From 1987 to 2004, 121 of 2460 patients who underwent gastric EMR at the National Cancer Center Hospital had gastric perforation during EMR (4.9%). The initial 4 patients were treated with emergent surgery. The subsequent 117 patients who were treated with endoclips formed our study population. RESULTS: Endoscopic closure with endoclips in 115 patients (98.3%) was successful. Two patients with unsuccessful endoscopic closure underwent emergent surgery. In the past 6 years, patients with perforation during gastric EMR treated with endoscopic closure had a recovery rate similar to that of the nonperforation cases. CONCLUSIONS: Gastric perforation during endoscopic resection can be conservatively treated by complete endoscopic closure with endoclips.