Clinical Factors of Delayed Perforation after Endoscopic Submucosal Dissection for Gastric Neoplasms.

Yoshinobu Yamamoto,Masahiro Tsuda,Hiroaki Sawai,Hidetaka Tsumura,Nagahiro Tokuyama,Takuya Mimura,Hideki Sakai,Hogara Nishisaki,Saeko Kushida,Takeshi Sakamoto,Ikuya Miki,Aya Sakai,Hideto Inokuchi

doi:10.1155/2017/7404613

Yoshinobu Yamamoto, Masahiro Tsuda + Show 11 more

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https://doi.org/10.1155/2017/7404613

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Abstract

Background Delayed perforation is a rare but severe complication of endoscopic submucosal dissection (ESD) for early gastric neoplasm (EGN). The aim of this study was to clarify clinical factors related to delayed perforation after ESD. Methods A total of 1158 consecutive patients with 1199 EGNs underwent ESD at our hospital between January 2000 and December 2015. Univariate analysis was used to identify clinicopathological factors related to delayed perforation. Moreover, duration of cautery needed for hemostasis was measured by comparison between perforated and nonperforated points in patients with delayed perforation. Results Delayed perforation occurred in 5 of 1158 consecutive patients with 1199 EGNs who underwent ESD (0.42%). All cases were diagnosed within 24 h after ESD and recovered with conservative management. On univariate analysis, location in the upper stomach was the factor most significantly associated with delayed perforation (P < 0.01). Duration of cautery needed for hemostasis was significantly longer at perforated points (9 s) than at nonperforated points (3.5 s) in five patients. Conclusions Location in the upper stomach was the risk factor most prominently associated with delayed perforation after ESD for EGNs. In addition, delayed perforation appears associated with excessive electrocautery for hemostasis.

Highlights

Endoscopic submucosal dissection (ESD) has become widespread as a treatment for early gastric neoplasms (EGNs) with a negligible risk of lymph node metastasis, such as early gastric cancer (EGC) and adenoma [1]
Most perforations occur during the endoscopic submucosal dissection (ESD) procedures, with rates reportedly ranging from 1.2% to 9.6% [2,3,4,5,6,7,8,9]
Delayed perforation occurs after completion of ESD, even when perforation is not detected during the ESD procedure

Summary

Introduction

Endoscopic submucosal dissection (ESD) has become widespread as a treatment for early gastric neoplasms (EGNs) with a negligible risk of lymph node metastasis, such as early gastric cancer (EGC) and adenoma [1]. Some studies have reported rates of delayed perforation of 0.06–0.45% after gastric ESD [3, 10,11,12,13]. Clinical risk factors and methods for the management of delayed perforation after ESD for EGN are described in this report. Delayed perforation is a rare but severe complication of endoscopic submucosal dissection (ESD) for early gastric neoplasm (EGN). Delayed perforation occurred in 5 of 1158 consecutive patients with 1199 EGNs who underwent ESD (0.42%). Duration of cautery needed for hemostasis was significantly longer at perforated points (9 s) than at nonperforated points (3.5 s) in five patients. Location in the upper stomach was the risk factor most prominently associated with delayed perforation after ESD for EGNs. In addition, delayed perforation appears associated with excessive electrocautery for hemostasis

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