Clinical outcomes and risk factors for perforation in gastric endoscopic submucosal dissection: A prospective pilot study

Abstract

AIM: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. CONCLUSION: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. Key words: Gastric cancer; Endoscopic submucosal dissection; Perforation; Risk factors; Treatment outcome Core tip: There has been little prospective study on the clinical outcomes of endoscopic perforation in endoscopic submucosal dissection for gastric neoplasia. In the current study, we investigated clinical outcomes of perforation during gastric endoscopic submucosal dissection, and analyzed various demographic and clinical parameters for risk factors. The results clearly demonstrated that prolonged procedure time (≥ 115 min),

Endoscopic Submucosal Dissection for Gastric Neoplasm at an Outpatient Clinic: Efficacy and Safety

“…Perforation during procedure can be shown in up to 8%. 6 , 9 , 10 , 15 , 16 Even though, in this study, perforation was found only in one case, the risk factors for perforation were reported when tumor is located middle or upper third of the stomach, size is larger than 2 cm, and procedure time is delayed. After finding or suspecting the perforation during endoscopic resection, most cases of perforation can be controlled by endoscopic management using clip with antibiotics administration.…”

Complications Related to Gastric Endoscopic Submucosal Dissection and Their Managements

“…Intraoperative perforation occurs at a rate of 1.2% to 8.2% during gastric ESD. 6 , 8 , 14 , 15 At our institute, the rate of intraoperative perforation is 0.5% (3 of the total of 546 cases between 2009 and 2013). The tumor location (middle and upper thirds of the gastric body), tumor diameter (larger size, e.g., >2 cm), ulcerative findings (presence), and longer operation time (e.g., >2 hours) are reported to be the independent risk factors for intraoperative perforation.…”

“…The tumor location (middle and upper thirds of the gastric body), tumor diameter (larger size, e.g., >2 cm), ulcerative findings (presence), and longer operation time (e.g., >2 hours) are reported to be the independent risk factors for intraoperative perforation. 6 , 14 , 15 …”

Endoscopic submucosal dissection of gastric adenomas using the clutch cutter

“…The second fashion is post-ESD perforation that ordinarily shows 1-2 d after the ESD procedure because of deep coagulation. Intra-ESD perforation reportedly occurs in 1.2%-8.2% of gastric ESDs[ 3 , 5 , 21 , 22 ]. Avoiding electric damage to the proper muscle layer is important to avoid unintended incisions.…”