title: Clinical outcomes and risk factors for perforation in gastric endoscopic submucosal dissection: A prospective pilot study.
abstract: OBJECTIVE
  To evaluate clinical outcomes and risk factors for endoscopic perforation during endoscopic submucosal dissection (ESD) in a prospective study.
  
  
  METHODS
  We investigated the clinical outcomes and risk factors for the development of perforation in 98 consecutive gastric neoplasms undergoing ESD regarding. Demographic and clinical parameters including patient-, tumor-, and treatment-related factors, clinical parameters, and duration of hospital stay were analyzed for risk factors for perforation. In subgroup analysis, we also compared the clinical outcomes between perforation and "silent" free air without endoscopically visible perforation detected only by computed tomography.
  
  
  RESULTS
  Perforation was identified in 8.2% of patients. All patients were managed conservatively by the administration of antibiotics. The mean procedure time was significantly longer in patients with endoscopic perforation than in those without. According to the receiver-operating characteristic analysis, the resulting cutoff value of the procedure time for perforation was 115 min (87.5% sensitivity, 56.7% specificity). Prolonged procedure time (≥ 115 min) was associated with an increased risk of perforation (odds ratio 9.15; 95%CI: 1.08-77.54; P = 0.04). Following ESD, body temperature and C-reactive protein level were significantly higher in patients with perforation than in those without (P = 0.02), whereas there was no difference between these patient groups on the starting day of oral intake or of hospitalization. In subgroup analysis, the post-ESD clinical course was not different between endoscopic perforation and silent free air.
  
  
  CONCLUSIONS
  Only prolonged procedure time (≥ 115 min) was significantly associated with perforation. The clinical outcomes of perforation are favorable and are comparable to those of patients with or without silent free air.
authors.affiliation: Jiro Watari, Toshihiko Tomita, Fumihiko Toyoshima, Jun Sakurai, Takashi Kondo, Haruki Asano, Takahisa Yamasaki, Takuya Okugawa, Hisatomo Ikehara, Tadayuki Oshima, Hirokazu Fukui, Hiroto Miwa, Division of Upper Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan.
authors.forename: Jiro
authors.initials: J
authors.lastname: Watari
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Tomita
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Toyoshima
authors.forename: Jun
authors.initials: J
authors.lastname: Sakurai
authors.forename: Takashi
authors.initials: T
authors.lastname: Kondo
authors.forename: Haruki
authors.initials: H
authors.lastname: Asano
authors.forename: Takahisa
authors.initials: T
authors.lastname: Yamasaki
authors.forename: Takuya
authors.initials: T
authors.lastname: Okugawa
authors.forename: Hisatomo
authors.initials: H
authors.lastname: Ikehara
authors.forename: Tadayuki
authors.initials: T
authors.lastname: Oshima
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Fukui
authors.forename: Hiroto
authors.initials: H
authors.lastname: Miwa
keywords: Endoscopic submucosal dissection; Gastric cancer; Perforation; Risk factors; Treatment outcome