title: Perforation and postoperative bleeding of endoscopic submucosal dissection in gastric tumors: analysis of 1190 lesions in low- and high-volume centers in Saga, Japan.
abstract: BACKGROUND
  This retrospective study aimed to determine risk factors associated with serious complications of endoscopic submucosal dissection of gastric tumors in multicenters compared between high- and low-volume centers.
  
  
  METHODS
  Between 2001 and 2010, gastric endoscopic submucosal dissection was performed in 1190 lesions of 1082 patients in five hospitals in Saga, three high-volume and two low-volume centers. Risk factors for serious complications were evaluated. Patients' background characteristics were evaluated, including anticoagulants use and underlying diseases.
  
  
  RESULTS
  Postoperative bleeding was detected in 75 patients (6.9%), and perforation was detected in 40 patients (3.7%). Most postoperative bleeding and perforation cases were recovered with endoscopic procedures, although one case of each complication was treated by emergency surgery. Multivariate analysis indicated that risk factors for perforation were tumor location, massive submucusal invasion, endoscopists' experience of 100-149 cases and hypertension, and that risk factors for postoperative bleeding were tumor location, resected tumor size, and scar lesion. The serious complications were not different between high- and low-volume centers.
  
  
  CONCLUSIONS
  The present study indicated that risk factors for perforation during endoscopic submucosal dissection were tumor, endoscopist and patient related, although risk factors for postoperative bleeding were tumor related. There was no difference in complications between high- and low-volume centers.
authors.affiliation: Department of Internal Medicine and Gastrointestinal Endoscopy, Saga Prefectural Hospital Koseikan, Saga, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Miyahara
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Iwakiri
authors.forename: Ryo
authors.initials: R
authors.lastname: Shimoda
authors.forename: Yasuhisa
authors.initials: Y
authors.lastname: Sakata
authors.forename: Takehiro
authors.initials: T
authors.lastname: Fujise
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Shiraishi
authors.forename: Kanako
authors.initials: K
authors.lastname: Yamaguchi
authors.forename: Akira
authors.initials: A
authors.lastname: Watanabe
authors.forename: Daisuke
authors.initials: D
authors.lastname: Yamaguchi
authors.forename: Toru
authors.initials: T
authors.lastname: Higuchi
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Tominaga
authors.forename: Shinichi
authors.initials: S
authors.lastname: Ogata
authors.forename: Nanae
authors.initials: N
authors.lastname: Tsuruoka
authors.forename: Takahiro
authors.initials: T
authors.lastname: Noda
authors.forename: Hidenori
authors.initials: H
authors.lastname: Hidaka
authors.forename: Kotaro
authors.initials: K
authors.lastname: Mannen
authors.forename: Hiroyoshi
authors.initials: H
authors.lastname: Endo
authors.forename: Kohei
authors.initials: K
authors.lastname: Yamanouchi
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Yamazato
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Sakata
authors.forename: Kazuma
authors.initials: K
authors.lastname: Fujimoto
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004210:Dissection / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology* / Q000209:etiology; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013270:Stomach / Q000293:injuries*; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate / Q000639:trends