Predictive risk factors of perforation in gastric endoscopic submucosal dissection for early gastric cancer: a large, multicenter study

Kim, Min; Jeon, Seong Woo; Cho, Kwang Bum; Park, Kyung Sik; Kim, Eun Soo; Park, Chang Keun; Seo, Hyang Eun; Chung, Yun Jin; Kwon, Joong Goo; Jung, Jin Tae; Kim, Eun Young; Jang, Byeong Ik; Lee, Si Hyung; Kim, Kyeong Ok; Yang, Chang Heon

doi:10.1007/s00464-012-2618-4

Cited by 39 publications

(23 citation statements)

References 19 publications

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“…Additionally, in the control group, proximal gastric lesions were noted to be more challenging, consistent with clinical experience. 24,25 However, when using the suture-pulley method, there was no difference in resection time or degree of difficulty with regard to lesion location. This suggests that the suture-pulley method may make the more complicated ESDs more feasible, in addition to making more straightforward ESDs more efficient.…”

Section: Discussionmentioning

confidence: 99%

Facilitating endoscopic submucosal dissection: the suture-pulley method significantly improves procedure time and minimizes technical difficulty compared with conventional technique: an ex vivo study (with video)

Aihara

Kumar

Ryou

et al. 2014

Gastrointestinal Endoscopy

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Background The lack of countertraction in endoscopic submucosal dissection (ESD) results in increased technical demand and procedure time. Although the suture-pulley method for countertraction has been reported, its effectiveness compared with the traditional ESD technique remains unclear. Objective To objectively analyze efficacy of countertraction using the suture-pulley method for ESD. Design Prospective ex vivo animal study. Setting Animal laboratory. Interventions Twenty simulated gastric lesions were created in porcine stomachs by using a standard circular template 30 mm in diameter. In the control arm (n = 10), ESD was performed by using the standard technique. In the suture-pulley arm (N = 10), a circumferential incision was made, and an endoscopic suturing device was used to place the suture pulley. Main Outcome Measurements The primary outcome of this study was total procedure time. Results The median total procedure time with the suture-pulley method was significantly shorter than the traditional ESD technique (median, 25% to 75%, interquartile range [IQR]: 531 seconds [474.3–549.3 seconds] vs 845 seconds [656.3–1547.5 seconds], P < .001). The median time (IQR) for suture-pulley placement was 160.5 seconds (150.0–168.8 seconds). Although there was a significantly longer procedure time for proximal versus middle/lower stomach lesions with traditional ESD (median, 1601 seconds; IQR, 1547.5–1708.8 seconds vs median, 663 seconds; IQR, 627.5–681.8 seconds; P =.01), there was no significant difference in procedure time for lesions of various locations when using the suture-pulley method. Compared with traditional ESD, the suture-pulley method was less demanding in all categories evaluated by the NASA Task Load Index. Limitations Ex vivo study. Conclusions The suture-pulley method facilitates direct visualization of the submucosal layer during ESD and significantly reduces procedure time and technical difficulty. In addition, the benefit of the suture-pulley method was seen for both simple and more complicated ESDs.

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Section: Discussionmentioning

confidence: 99%

Facilitating endoscopic submucosal dissection: the suture-pulley method significantly improves procedure time and minimizes technical difficulty compared with conventional technique: an ex vivo study (with video)

Aihara

Kumar

Ryou

et al. 2014

Gastrointestinal Endoscopy

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“…Many studies have reported the upper-third location as associated with a higher rate of perforation during ESD [3, 6–8, 21]. In terms of bleeding, Oda et al reported that rates of significant immediate bleeding are higher in the upper and middle thirds of the stomach than in the lower third because of the larger diameter of the submucosal arteries in the upper and middle thirds [3, 4, 22].…”

Section: Discussionmentioning

confidence: 99%

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

Yamamoto

Nishisaki

Sakai

et al. 2017

Gastroenterology Research and Practice

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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.

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“…Although most perforations are managed through conservative treatment with endoscopic closure, surgery is needed in 2.5~3.3% of patients with perforation [12–14]. Previous studies reported that the upper area of the stomach, piecemeal resection, and long procedure times were risk factors associated with perforation after ESD [13–16, 20].…”

Section: Discussionmentioning

confidence: 99%

“…Iatrogenic perforations induced by gastric ESD and EMR have been reported to occur in approximately 4% and 1% of cases, respectively [10, 11]. Most perforations can be managed through endoscopic closure and conservative treatment, but surgery is required in rare cases [12–14]. A delay in deciding to perform surgery may cause fatal clinical outcomes in some patients.…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Additional Surgery after Iatrogenic Perforations due to Endoscopic Submucosal Dissection

Kim

Park

Kim

et al. 2017

Gastroenterology Research and Practice

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Objectives. Endoscopic resection (ER) is commonly performed to treat gastric epithelial neoplasms and subepithelial tumors. The aim of this study was to predict the risk factors for surgery after ER-induced perforation. Methods. We retrospectively reviewed the data on patients who received gastric endoscopic submucosal dissection (ESD) or endoscopic mucosal resection (EMR) between January 2010 and March 2015. Patients who were confirmed to have perforation were classified into surgery and nonsurgery groups. We aimed to determine the risk factors for surgery in patients who developed iatrogenic gastric perforations. Results. A total of 1183 patients underwent ER. Perforation occurred in 69 (5.8%) patients, and 9 patients (0.8%) required surgery to manage the perforation. In univariate analysis, anterior location of the lesion, a subepithelial lesion, two or more postprocedure pain killers within 24 hrs, and increased heart rate within 24 hrs after the procedure were the factors related to surgery. In logistic regression analysis, the location of the lesion at the anterior wall and using two or more postprocedure pain killers within 24 hrs were risk factors for surgery. Conclusion. Most cases of perforations after ER can be managed conservatively. When a patient requires two or more postprocedure pain killers within 24 hrs and the lesion is located on the anterior wall, early surgery should be considered instead of conservative management.

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Predictive risk factors of perforation in gastric endoscopic submucosal dissection for early gastric cancer: a large, multicenter study

Abstract: The result of this study demonstrated that the location of the lesion (body) and piecemeal resection were related to perforation during ESD.

Cited by 39 publications

References 19 publications

Facilitating endoscopic submucosal dissection: the suture-pulley method significantly improves procedure time and minimizes technical difficulty compared with conventional technique: an ex vivo study (with video)

Facilitating endoscopic submucosal dissection: the suture-pulley method significantly improves procedure time and minimizes technical difficulty compared with conventional technique: an ex vivo study (with video)

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

Risk Factors for Additional Surgery after Iatrogenic Perforations due to Endoscopic Submucosal Dissection

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