title: Risk factors for intraoperative perforation during endoscopic submucosal dissection of superficial esophageal squamous cell carcinoma.
abstract: OBJECTIVE
  To identify the risk factors and clarify the subsequent clinical courses.
  
  
  METHODS
  This study retrospectively analyzed consecutive patients with esophageal squamous cell carcinoma (ESCC) treated using endoscopic submucosal dissection (ESD) between April 2008 and October 2012. We divided the ESCC lesions into perforation cases and non-perforation cases, and compared characteristics and endoscopic findings between the two groups. "Intraoperative perforation" was defined as the detection of a perforation site during ESD and the presence of mediastinal emphysema.
  
  
  RESULTS
  In total, 147 patients with 156 ESCC lesions were treated by ESD. Intraoperative perforation was recorded for nine lesions (5.8%) from nine patients. Multivariate analysis identified mucosal deficiency larger than 75% of the circumference of the esophagus as an independent risk factor for intraoperative perforation (OR = 7.37, 95%CI: 1.45-37.4,P= 0.016). The predominant site of perforation was the left wall [6/9 (67%)]. Six of nine perforation sites were successfully closed by clips during the procedures. Two of nine cases required drainage for pleural effusions; however, all nine cases recovered with conservative treatment and without surgical intervention. At the median follow up of 42 mo after ESD, no cases of local recurrence or distant organ metastasis had been observed.
  
  
  CONCLUSIONS
  This study suggests that mucosal deficiency larger than 75% of the luminal circumference is a risk factor for intraoperative perforation during ESD for ESCC.
authors.affiliation: Masaaki Noguchi, Tomonori Yano, Tomoji Kato, Tomohiro Kadota, Maomi Imajoh, Hiroyuki Morimoto, Shozo Osera, Atsushi Yagishita, Tomoyuki Odagaki, Yusuke Yoda, Yasuhiro Oono, Hiroaki Ikematsu, Kazuhiro Kaneko, Department of Gastroenterology, Endoscopy division, National Cancer Center Hospital East, Chiba 277-8577, Japan.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Noguchi
authors.affiliation: Masaaki Noguchi, Tomonori Yano, Tomoji Kato, Tomohiro Kadota, Maomi Imajoh, Hiroyuki Morimoto, Shozo Osera, Atsushi Yagishita, Tomoyuki Odagaki, Yusuke Yoda, Yasuhiro Oono, Hiroaki Ikematsu, Kazuhiro Kaneko, Department of Gastroenterology, Endoscopy division, National Cancer Center Hospital East, Chiba 277-8577, Japan.
authors.forename: Tomonori
authors.initials: T
authors.lastname: Yano
authors.affiliation: Masaaki Noguchi, Tomonori Yano, Tomoji Kato, Tomohiro Kadota, Maomi Imajoh, Hiroyuki Morimoto, Shozo Osera, Atsushi Yagishita, Tomoyuki Odagaki, Yusuke Yoda, Yasuhiro Oono, Hiroaki Ikematsu, Kazuhiro Kaneko, Department of Gastroenterology, Endoscopy division, National Cancer Center Hospital East, Chiba 277-8577, Japan.
authors.forename: Tomoji
authors.initials: T
authors.lastname: Kato
authors.affiliation: Masaaki Noguchi, Tomonori Yano, Tomoji Kato, Tomohiro Kadota, Maomi Imajoh, Hiroyuki Morimoto, Shozo Osera, Atsushi Yagishita, Tomoyuki Odagaki, Yusuke Yoda, Yasuhiro Oono, Hiroaki Ikematsu, Kazuhiro Kaneko, Department of Gastroenterology, Endoscopy division, National Cancer Center Hospital East, Chiba 277-8577, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Kadota
authors.affiliation: Masaaki Noguchi, Tomonori Yano, Tomoji Kato, Tomohiro Kadota, Maomi Imajoh, Hiroyuki Morimoto, Shozo Osera, Atsushi Yagishita, Tomoyuki Odagaki, Yusuke Yoda, Yasuhiro Oono, Hiroaki Ikematsu, Kazuhiro Kaneko, Department of Gastroenterology, Endoscopy division, National Cancer Center Hospital East, Chiba 277-8577, Japan.
authors.forename: Maomi
authors.initials: M
authors.lastname: Imajoh
authors.affiliation: Masaaki Noguchi, Tomonori Yano, Tomoji Kato, Tomohiro Kadota, Maomi Imajoh, Hiroyuki Morimoto, Shozo Osera, Atsushi Yagishita, Tomoyuki Odagaki, Yusuke Yoda, Yasuhiro Oono, Hiroaki Ikematsu, Kazuhiro Kaneko, Department of Gastroenterology, Endoscopy division, National Cancer Center Hospital East, Chiba 277-8577, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Morimoto
authors.affiliation: Masaaki Noguchi, Tomonori Yano, Tomoji Kato, Tomohiro Kadota, Maomi Imajoh, Hiroyuki Morimoto, Shozo Osera, Atsushi Yagishita, Tomoyuki Odagaki, Yusuke Yoda, Yasuhiro Oono, Hiroaki Ikematsu, Kazuhiro Kaneko, Department of Gastroenterology, Endoscopy division, National Cancer Center Hospital East, Chiba 277-8577, Japan.
authors.forename: Shozo
authors.initials: S
authors.lastname: Osera
authors.affiliation: Masaaki Noguchi, Tomonori Yano, Tomoji Kato, Tomohiro Kadota, Maomi Imajoh, Hiroyuki Morimoto, Shozo Osera, Atsushi Yagishita, Tomoyuki Odagaki, Yusuke Yoda, Yasuhiro Oono, Hiroaki Ikematsu, Kazuhiro Kaneko, Department of Gastroenterology, Endoscopy division, National Cancer Center Hospital East, Chiba 277-8577, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Yagishita
authors.affiliation: Masaaki Noguchi, Tomonori Yano, Tomoji Kato, Tomohiro Kadota, Maomi Imajoh, Hiroyuki Morimoto, Shozo Osera, Atsushi Yagishita, Tomoyuki Odagaki, Yusuke Yoda, Yasuhiro Oono, Hiroaki Ikematsu, Kazuhiro Kaneko, Department of Gastroenterology, Endoscopy division, National Cancer Center Hospital East, Chiba 277-8577, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Odagaki
authors.affiliation: Masaaki Noguchi, Tomonori Yano, Tomoji Kato, Tomohiro Kadota, Maomi Imajoh, Hiroyuki Morimoto, Shozo Osera, Atsushi Yagishita, Tomoyuki Odagaki, Yusuke Yoda, Yasuhiro Oono, Hiroaki Ikematsu, Kazuhiro Kaneko, Department of Gastroenterology, Endoscopy division, National Cancer Center Hospital East, Chiba 277-8577, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Yoda
authors.affiliation: Masaaki Noguchi, Tomonori Yano, Tomoji Kato, Tomohiro Kadota, Maomi Imajoh, Hiroyuki Morimoto, Shozo Osera, Atsushi Yagishita, Tomoyuki Odagaki, Yusuke Yoda, Yasuhiro Oono, Hiroaki Ikematsu, Kazuhiro Kaneko, Department of Gastroenterology, Endoscopy division, National Cancer Center Hospital East, Chiba 277-8577, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Oono
authors.affiliation: Masaaki Noguchi, Tomonori Yano, Tomoji Kato, Tomohiro Kadota, Maomi Imajoh, Hiroyuki Morimoto, Shozo Osera, Atsushi Yagishita, Tomoyuki Odagaki, Yusuke Yoda, Yasuhiro Oono, Hiroaki Ikematsu, Kazuhiro Kaneko, Department of Gastroenterology, Endoscopy division, National Cancer Center Hospital East, Chiba 277-8577, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Ikematsu
authors.affiliation: Masaaki Noguchi, Tomonori Yano, Tomoji Kato, Tomohiro Kadota, Maomi Imajoh, Hiroyuki Morimoto, Shozo Osera, Atsushi Yagishita, Tomoyuki Odagaki, Yusuke Yoda, Yasuhiro Oono, Hiroaki Ikematsu, Kazuhiro Kaneko, Department of Gastroenterology, Endoscopy division, National Cancer Center Hospital East, Chiba 277-8577, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Kaneko
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000150:complications* / Q000473:pathology / Q000601:surgery; D004322:Drainage; D000069916:Endoscopic Mucosal Resection / Q000009:adverse effects*; D004938:Esophageal Neoplasms / Q000150:complications* / Q000473:pathology / Q000601:surgery; D004939:Esophageal Perforation / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D000077277:Esophageal Squamous Cell Carcinoma; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology* / Q000628:therapy; D008297:Male; D008478:Mediastinal Emphysema / Q000209:etiology*; D008875:Middle Aged; D009092:Mucous Membrane / Q000473:pathology*; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D016066:Pleural Effusion, Malignant / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Endoscopic submucosal dissection; Esophageal carcinoma; Perforation; Risk factor