title: Management and associated factors of delayed perforation after gastric endoscopic submucosal dissection.
abstract: OBJECTIVE
  To identify the actual clinical management and associated factors of delayed perforation after gastric endoscopic submucosal dissection (ESD).
  
  
  METHODS
  A total of 4943 early gastric cancer (EGC) patients underwent ESD at our hospital between January 1999 and June 2012. We retrospectively assessed the actual management of delayed perforation. In addition, to determine the factors associated with delayed perforation, after excluding 123 EGC patients with perforations that occurred during the ESD procedure, we analyzed the following clinicopathological factors among the remaining 4820 EGC patients by comparing the ESD cases with delayed perforation and the ESD cases without perforation: age, sex, chronological periods, clinical indications for ESD, status of the stomach, location, gastric circumference, tumor size, invasion depth, presence/absence of ulceration, histological type, type of resection, and procedure time.
  
  
  RESULTS
  Delayed perforation occurred in 7 (0.1%) cases. The median time until the occurrence of delayed perforation was 11 h (range, 6-172 h). Three (43%) of the 7 cases required emergency surgery, while four were conservatively managed without surgical intervention. Among the 4 cases with conservative management, 2 were successfully managed endoscopically using the endoloop-endoclip technique. The median hospital stay was 18 d (range, 15-45 d). There were no delayed perforation-related deaths. Based on a multivariate analysis, gastric tube cases (OR = 11.0; 95%CI: 1.7-73.3; P = 0.013) were significantly associated with delayed perforation.
  
  
  CONCLUSIONS
  Endoscopists must be aware of not only the identified factors associated with delayed perforation, but also how to treat this complication effectively and promptly.
authors.affiliation: Haruhisa Suzuki, Ichiro Oda, Masau Sekiguchi, Seiichiro Abe, Satoru Nonaka, Shigetaka Yoshinaga, Takeshi Nakajima, Yutaka Saito, Endoscopy Division, National Cancer Center Hospital, Tokyo 104-0045, Japan.
authors.forename: Haruhisa
authors.initials: H
authors.lastname: Suzuki
authors.affiliation: Haruhisa Suzuki, Ichiro Oda, Masau Sekiguchi, Seiichiro Abe, Satoru Nonaka, Shigetaka Yoshinaga, Takeshi Nakajima, Yutaka Saito, Endoscopy Division, National Cancer Center Hospital, Tokyo 104-0045, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Oda
authors.affiliation: Haruhisa Suzuki, Ichiro Oda, Masau Sekiguchi, Seiichiro Abe, Satoru Nonaka, Shigetaka Yoshinaga, Takeshi Nakajima, Yutaka Saito, Endoscopy Division, National Cancer Center Hospital, Tokyo 104-0045, Japan.
authors.forename: Masau
authors.initials: M
authors.lastname: Sekiguchi
authors.affiliation: Haruhisa Suzuki, Ichiro Oda, Masau Sekiguchi, Seiichiro Abe, Satoru Nonaka, Shigetaka Yoshinaga, Takeshi Nakajima, Yutaka Saito, Endoscopy Division, National Cancer Center Hospital, Tokyo 104-0045, Japan.
authors.forename: Seiichiro
authors.initials: S
authors.lastname: Abe
authors.affiliation: Haruhisa Suzuki, Ichiro Oda, Masau Sekiguchi, Seiichiro Abe, Satoru Nonaka, Shigetaka Yoshinaga, Takeshi Nakajima, Yutaka Saito, Endoscopy Division, National Cancer Center Hospital, Tokyo 104-0045, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Nonaka
authors.affiliation: Haruhisa Suzuki, Ichiro Oda, Masau Sekiguchi, Seiichiro Abe, Satoru Nonaka, Shigetaka Yoshinaga, Takeshi Nakajima, Yutaka Saito, Endoscopy Division, National Cancer Center Hospital, Tokyo 104-0045, Japan.
authors.forename: Shigetaka
authors.initials: S
authors.lastname: Yoshinaga
authors.affiliation: Haruhisa Suzuki, Ichiro Oda, Masau Sekiguchi, Seiichiro Abe, Satoru Nonaka, Shigetaka Yoshinaga, Takeshi Nakajima, Yutaka Saito, Endoscopy Division, National Cancer Center Hospital, Tokyo 104-0045, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nakajima
authors.affiliation: Haruhisa Suzuki, Ichiro Oda, Masau Sekiguchi, Seiichiro Abe, Satoru Nonaka, Shigetaka Yoshinaga, Takeshi Nakajima, Yutaka Saito, Endoscopy Division, National Cancer Center Hospital, Tokyo 104-0045, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Saito
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004210:Dissection / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D005773:Gastroscopy / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D016017:Odds Ratio; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013270:Stomach / Q000293:injuries / Q000601:surgery*; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*
keywords: Conservative management; Delayed perforation; Early gastric cancer; Emergency surgery; Endoscopic submucosal dissection