Evaluation of Complications of Endoscopic Submucosal Dissection in Gastric Tumors: Analysis in 482 Patients

Abstract

Introduction: Recently, developed endoscopic submucosal dissection (ESD) facilitated en bloc removal of widely spread lesions in the stomach. It is easily estimated that risks of complications including post bleeding, perforation and postoperative stenosis might be increased compared to conventional endoscopic mucosal resection. There are, however, few reports regarding complication caused by ESD. This retrospective study aimed to determine factors which influenced serious complications of ESD. Aims and Methods: We have performed ESD for 482 cases (males: females, 353: 129; age: 71.0 ± 8.6 years) from December, 2001 to March, 2007. We experienced 40 patients with delayed bleeding, 19 patients with perforation, and 5 patients with stricture. Risk factors of patients who received ESD in gastric mucosal tumors for complications were evaluated focusing on resected size, location and operation time, and experience of endoscopists who performed ESD. We also evaluated patients background characteristics including sex, age, BMI, postoperative white blood-cell count (WBC), postoperative C-reactive protein (CRP), drug history of anticoagulant, and underlying diseases of cerebrovascular disorder, ischemic heart disease, liver dysfunction, renal dysfunction, hyperuricemia, hypertension and diabetes mellitus. Results: Regarding post bleeding, a significant risk factor was resected size (P <0.0001). Odds ratio was 8.2 in higher than 51mm as a result of multivariate logistic regression analysis. Regarding perforation, two risk factors were determined, operation time (P=0.0002) and postoperative WBC (P=0.009). For operation time, odds ratio was 10.8 in longer than 2 hours as a result of multivariate logistic regression analysis. For postoperative WBC, odds ratio was 16.0 in >13000/μl. Regarding stricture, a number of patients was small, 5caces, and there was no significant risk factor, but stricture was limited in the cases with circumferential or subcircumferential resection in the antrum. Conclusion: This study suggested that risk factors for complications of ESD were resected size and operation time, although patients backgrounds including underlying disease were not related to complications. Although these two risk factors could be overcome by technical improvement, this study could not indicate experienced number of endoscopists as a risk factor. It is expected complications wil be overcome by technical improvements, various mesures, and instruction to beginners.