title: Predictive risk factors of perforation in gastric endoscopic submucosal dissection for early gastric cancer: a large, multicenter study.
abstract: BACKGROUND
  Although endoscopic submucosal dissection (ESD) is standard therapy for early gastric cancer, the complication rate is unsatisfactory, with perforation as the major complication during ESD. There have been several reports regarding the complications of ESD for gastric tumor especially perforation; however, little is known about the predictors for complications in patients undergoing ESD. The purpose of this retrospective study was to determine the risk factors for perforation in patients with early gastric cancer during ESD.
  
  
  METHODS
  Between February 2003 and May 2010, we performed ESD for 1,289 lesions in 1,246 patients at six tertiary academic hospitals in Daegu, Kyungpook, Korea. Patient-related variables (age, sex, and underlying disease), endoscopic-related variables (indication of ESD, lesion size, location, type, and mucosal ulceration), procedure-related variables (operation time, complete resection, and invasion of submucosa/vessel/lymph node), and the pathologic diagnosis were evaluated as potential risk factors.
  
  
  RESULTS
  The mean age of the patients was 64 years. The mean size of the endoscopic lesion was 19.4 mm. The overall en bloc resection rate was 93.3 %. Perforation (microperforation and macroperforation) was seen in 35 lesions. The location of the lesion (long axis: body/short axis: greater and lesser curvature) and piecemeal resection were associated with perforation (p = 0.01/0.047 and p = 0.049). Upon multivariate analysis, the location (body vs. antrum) of the lesion (odds ratio (OR) 2.636; 95 % confidence interval (CI) 1.319-5.267; p = 0.006) and piecemeal resection (OR 2.651; 95 % CI 1.056-6.656; p = 0.038) were significant predictive factors for perforation.
  
  
  CONCLUSIONS
  The result of this study demonstrated that the location of the lesion (body) and piecemeal resection were related to perforation during ESD.
authors.affiliation: Internal Medicine, Kyungpook National University School of Medicine, 50, Samduk 2-Ga, Chung-gu, Daegu, 700-721, South Korea.
authors.forename: Min
authors.initials: M
authors.lastname: Kim
authors.forename: Seong Woo
authors.initials: SW
authors.lastname: Jeon
authors.forename: Kwang Bum
authors.initials: KB
authors.lastname: Cho
authors.forename: Kyung Sik
authors.initials: KS
authors.lastname: Park
authors.forename: Eun Soo
authors.initials: ES
authors.lastname: Kim
authors.forename: Chang Keun
authors.initials: CK
authors.lastname: Park
authors.forename: Hyang Eun
authors.initials: HE
authors.lastname: Seo
authors.forename: Yun Jin
authors.initials: YJ
authors.lastname: Chung
authors.forename: Joong Goo
authors.initials: JG
authors.lastname: Kwon
authors.forename: Jin Tae
authors.initials: JT
authors.lastname: Jung
authors.forename: Eun Young
authors.initials: EY
authors.lastname: Kim
authors.forename: Byeong Ik
authors.initials: BI
authors.lastname: Jang
authors.forename: Si Hyung
authors.initials: SH
authors.lastname: Lee
authors.forename: Kyeong Ok
authors.initials: KO
authors.lastname: Kim
authors.forename: Chang Hun
authors.initials: CH
authors.lastname: Yang
mesh_terms: D004210:Dissection / Q000379:methods; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects* / Q000379:methods*; D005753:Gastric Mucosa / Q000601:surgery*; D005773:Gastroscopy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*