Clinical characteristics of patients with gastric perforation following endoscopic submucosal resection for gastric cancer.
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.
Abe
Yasunobu
Y
Gastroenterology Division, Yokohama City University School of Medicine, Yokohama, Japan.
Inamori
Masahiko
M
Iida
Hiroshi
H
Endo
Hiroki
H
Akiyama
Tomoyuki
T
Yoneda
Kyoko
K
Fujita
Koji
K
Takahashi
Hirokazu
H
Yoneda
Masato
M
Hirokawa
Satoru
S
Goto
Ayumu
A
Kirikoshi
Hiroyuki
H
Kobayashi
Noritoshi
N
Kubota
Kensuke
K
Saito
Satoru
S
Nakajima
Atsushi
A
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*