title: Risk factors for perforation and delayed bleeding associated with endoscopic submucosal dissection for early gastric neoplasms: analysis of 1123 lesions.
abstract: OBJECTIVE
  Endoscopic submucosal dissection (ESD) is a useful procedure for the treatment of early gastric neoplasms; however, this advanced technique has also resulted in an increase in serious complications such as perforation and delayed bleeding. This study aimed to elucidate the risk factors for these complications.
  
  
  METHODS
  A total of 1123 lesions diagnosed with early gastric neoplasms and treated by ESD at three institutions were investigated. Retrospectively, patients with or without these complications were compared on the basis of the patient characteristics and treatment results.
  
  
  RESULTS
  Perforation occurred in 27 lesions (2.4%) and delayed bleeding in 56 lesions (5.0%). Multivariate analysis indicated that lesions located in the upper area of the stomach (odds ratio [OR]: 4.88, 95% confidence interval [CI]: 2.21-10.75) was associated with a significantly higher risk of perforation, and that age ≥ 80 years (OR: 2.15, 95% CI: 1.18-3.90) and a long procedure time (OR: 1.01, 95% CI: 1.001-1.007) were associated with a significantly higher risk of delayed bleeding after ESD. The en bloc resection rate (74% vs 94%) and curative resection rate (48% vs 85%) of lesions with perforation were significantly lower than those without perforation. The rate of residual disease or recurrence after ESD was significantly higher in lesions with delayed bleeding than that without delayed bleeding (5.4% vs 0.84%).
  
  
  CONCLUSIONS
  This study demonstrated risk factors for perforation and delayed bleeding associated with ESD. Furthermore, it was clarified that perforation and delayed bleeding influenced post-procedure results and prognosis after ESD.
authors.affiliation: Department of Gastroenterology, National Hospital Organization Fukuyama Medical Center, Fukuyama, Japan. toyotatu@kmail.plala.or.jp
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Toyokawa
authors.forename: Tomoki
authors.initials: T
authors.lastname: Inaba
authors.forename: Shizuma
authors.initials: S
authors.lastname: Omote
authors.forename: Akiko
authors.initials: A
authors.lastname: Okamoto
authors.forename: Rika
authors.initials: R
authors.lastname: Miyasaka
authors.forename: Kazuo
authors.initials: K
authors.lastname: Watanabe
authors.forename: Koichi
authors.initials: K
authors.lastname: Izumikawa
authors.forename: Joichiro
authors.initials: J
authors.lastname: Horii
authors.forename: Isao
authors.initials: I
authors.lastname: Fujita
authors.forename: Shigenao
authors.initials: S
authors.lastname: Ishikawa
authors.forename: Tamiya
authors.initials: T
authors.lastname: Morikawa
authors.forename: Takako
authors.initials: T
authors.lastname: Murakami
authors.forename: Jun
authors.initials: J
authors.lastname: Tomoda
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000236:Adenoma / Q000473:pathology / Q000601:surgery*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016001:Confidence Intervals; D004210:Dissection / Q000009:adverse effects*; D005260:Female; D005753:Gastric Mucosa / Q000601:surgery; D005773:Gastroscopy / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000209:etiology*; D018365:Neoplasm, Residual; D016017:Odds Ratio; D019106:Postoperative Hemorrhage / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013270:Stomach / Q000293:injuries*; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D014947:Wounds and Injuries / Q000209:etiology