title: Delayed perforation: a hazardous complication of endoscopic resection for non-ampullary duodenal neoplasm.
abstract: BACKGROUND
  Perforation is a major complication of endoscopic resection for gastrointestinal neoplasms. However, little is known about delayed perforation after endoscopic resection for non-ampullary duodenal neoplasm. The aim of the present study was to investigate the clinical features of delayed perforation after endoscopic resection for non-ampullary duodenal neoplasm.
  
  
  METHODS
  This was a retrospective cohort study conducted in a referral cancer center. A total of 63 patients (41 with adenomas and 22 with carcinomas) underwent endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) from January 1993 to December 2011. Incidence, outcome, and factors associated with occurrence of delayed perforation were investigated.
  
  
  RESULTS
  Delayed perforation occurred in four patients (6.3%). All lesions were located distal to Vater's ampulla. Three of four delayed perforations occurred within 36 h after endoscopic resection. All patients developed retroperitonitis, and two also had retroperitoneal abscesses. Although three patients were cured with conservative management, a long hospital stay was required (28-, 80-, and 81-day hospital stay, respectively). One patient required emergency surgery as a result of panperitonitis. There was, fortunately, no mortality in this series. The significant predictors of delayed perforation were location (distal to Vater's ampulla, P = 0.007) and resection method (ESD and piecemeal EMR, P = 0.003).
  
  
  CONCLUSIONS
  Endoscopic resection for non-ampullary duodenal neoplasms has a possible risk of morbid complication i.e. delayed perforation, especially in patients with lesions located on the side distal from the ampulla and who are treated with piecemeal EMR or ESD.
authors.affiliation: Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Disease, Osaka, Japan; Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Inoue
authors.forename: Noriya
authors.initials: N
authors.lastname: Uedo
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yamashina
authors.forename: Sachiko
authors.initials: S
authors.lastname: Yamamoto
authors.forename: Noboru
authors.initials: N
authors.lastname: Hanaoka
authors.forename: Yoji
authors.initials: Y
authors.lastname: Takeuchi
authors.forename: Koji
authors.initials: K
authors.lastname: Higashino
authors.forename: Ryu
authors.initials: R
authors.lastname: Ishihara
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Iishi
authors.forename: Masaharu
authors.initials: M
authors.lastname: Tatsuta
authors.forename: Hidenori
authors.initials: H
authors.lastname: Takahashi
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Eguchi
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Ohigashi
mesh_terms: D000328:Adult; D004379:Duodenal Neoplasms / Q000601:surgery*; D004386:Duodenum; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007413:Intestinal Mucosa / Q000601:surgery; D007416:Intestinal Perforation / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D012422:Rupture, Spontaneous; D013997:Time Factors; D014057:Tomography, X-Ray Computed
keywords: complication; endoscopic mucosal resection (EMR); endoscopic submucosal dissection (ESD); non-ampullary duodenal tumor; perforation