title: Clinical characteristics of patients with gastric perforation following endoscopic submucosal resection for gastric cancer.
abstract: OBJECTIVE
  The aim of this study was to evaluate the risk factors of perforation during endoscopic submucosal dissection (ESD).
  
  
  METHODS
  ESD was performed using a Flex knife in 64 patients with a total of 67 gastric tumors. Perforation occurred at the sites of a total of 4 lesions (5.9% [4/67]) for which conservative treatment had been effective. We evaluated several possible risk factors for perforation following ESD, such as tumor size, the location of the lesion, the operation time, and other clinical factors.
  
  
  RESULTS
  All the perforations occurred in the posterior wall of the gastric upper or middle body. In an analysis adjusted for age and sex, the tumor size (odds ratio (OR), 1.017; 95% confidence interval (CI), 1.004-1.030), the location of the lesion in an upper region (OR, 10.64; 95%CI, 1.160-10.00) and the operation time (OR, 1.017; 95%CI, 1.013-1.295) were significantly associated with the incidence of perforation. All perforations were transient, resolving within 7 days, and did not require surgical treatment.
  
  
  CONCLUSIONS
  A large tumor size, the location of the lesion in an upper region, and a long operation time are risk factors for perforation following ESD.
authors.affiliation: Gastroenterology Division, Yokohama City University School of Medicine, Yokohama, Japan.
authors.forename: Yasunobu
authors.initials: Y
authors.lastname: Abe
authors.forename: Masahiko
authors.initials: M
authors.lastname: Inamori
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Iida
authors.forename: Hiroki
authors.initials: H
authors.lastname: Endo
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Akiyama
authors.forename: Kyoko
authors.initials: K
authors.lastname: Yoneda
authors.forename: Koji
authors.initials: K
authors.lastname: Fujita
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Takahashi
authors.forename: Masato
authors.initials: M
authors.lastname: Yoneda
authors.forename: Satoru
authors.initials: S
authors.lastname: Hirokawa
authors.forename: Ayumu
authors.initials: A
authors.lastname: Goto
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kirikoshi
authors.forename: Noritoshi
authors.initials: N
authors.lastname: Kobayashi
authors.forename: Kensuke
authors.initials: K
authors.lastname: Kubota
authors.forename: Satoru
authors.initials: S
authors.lastname: Saito
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nakajima
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004210:Dissection / Q000009:adverse effects*; D004724:Endoscopy / Q000009:adverse effects*; D005260:Female; D005753:Gastric Mucosa / Q000293:injuries*; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery*