title: Factors predicting perforation during endoscopic submucosal dissection for gastric cancer.
abstract: BACKGROUND
  Perforation is a common complication of endoscopic submucosal dissection (ESD), but little is known about the relevant risk factors.
  
  
  OBJECTIVE
  To investigate the risk factors for perforation.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  A cancer referral center.
  
  
  METHODS
  A total of 1795 early gastric tumors in 1500 patients treated by ESD from July 2002 to December 2010 were included in the analysis.
  
  
  METHODS
  The associations between the incidence of perforation and patient and lesion characteristics were investigated.
  
  
  RESULTS
  Perforation during ESD occurred in 50 lesions (2.8%). Univariate analysis identified tumor location (upper, middle, or lower stomach), tumor diameter (≤ 20 or >20 mm), and treatment period (lesions treated in the first or second period) as predictors of perforation. Multivariate analysis identified tumor location (upper stomach), tumor diameter (>20 mm), and treatment period (first half) as independent risk factors for perforation. The odds ratios were 2.4 (95% CI, 1.3-4.7; P = .006) for lesions in the upper stomach and 1.9 (95% CI, 1.0-3.5; P = .04) for lesions larger than 20 mm. Perforation risks were 5.4% for lesions in the upper stomach and 4.4% for lesions larger than 20 mm. Three patients required emergency surgery, but the rest of the patients were successfully treated with endoscopic clipping. There was no perforation-related mortality.
  
  
  CONCLUSIONS
  Single-center, retrospective study design.
  
  
  CONCLUSIONS
  Lesions in the upper stomach and lesions larger than 20 mm were independent risk factors for perforation during ESD. Patients should be made aware of the estimated high risks of these lesions before undergoing ESD.
authors.affiliation: Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Ohta
authors.forename: Ryu
authors.initials: R
authors.lastname: Ishihara
authors.forename: Noriya
authors.initials: N
authors.lastname: Uedo
authors.forename: Yoji
authors.initials: Y
authors.lastname: Takeuchi
authors.forename: Kengo
authors.initials: K
authors.lastname: Nagai
authors.forename: Fumi
authors.initials: F
authors.lastname: Matsui
authors.forename: Natsuko
authors.initials: N
authors.lastname: Kawada
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yamashina
authors.forename: Hiromitsu
authors.initials: H
authors.lastname: Kanzaki
authors.forename: Masao
authors.initials: M
authors.lastname: Hanafusa
authors.forename: Sachiko
authors.initials: S
authors.lastname: Yamamoto
authors.forename: Noboru
authors.initials: N
authors.lastname: Hanaoka
authors.forename: Koji
authors.initials: K
authors.lastname: Higashino
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Iishi
mesh_terms: D000368:Aged; D016001:Confidence Intervals; D004210:Dissection / Q000009:adverse effects*; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects*; D005753:Gastric Mucosa / Q000601:surgery; D006801:Humans; D015999:Multivariate Analysis; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D013270:Stomach / Q000293:injuries* / Q000601:surgery; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery*