Risk factors for complications of endoscopic submucosal dissection in gastric tumors: analysis of 478 lesions

Mannen, Kotaro; Tsunada, Seiji; Hara, Megumi; Yamaguchi, Kuniko; Sakata, Yasuhisa; Fujise, Takehiro; Noda, Takahiro; Shimoda, Ryo; Sakata, Hiroyuki; Ogata, Shinichi; Iwakiri, Ryuichi; Fujimoto, Kazuma

doi:10.1007/s00535-009-0137-4

Cited by 147 publications

(174 citation statements)

References 39 publications

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“…In the current study, a procedure time exceeding 115 min was considered to be a reliable marker associated with perforation development by ROC curve analysis. Thus, prolonged procedure time was a highly significant factor for endoscopic perforation; this finding is consistent with those of other studies [9,[11][12][13]16] . However, tumor location was not related to perforation.…”

Section: Clinical Course In Patients With Perforationsupporting

confidence: 92%

“…In our previous study [17] , tumor location was also not an independent risk factor for silent free air. Previous studies showed that tumor location (the upper portion of the stomach) was a significant and independent predictor of perforation by multivariate analysis [8][9][10][11][12][13]16,17] . A possible explanation for the discrepancy may be the difference in the number of patients with perforation investigated between ours and other studies.…”

Section: Clinical Course In Patients With Perforationmentioning

confidence: 99%

“…Indeed, only 8 of the patients in our study had perforation. In reports from Japan and South Korea, perforation was observed in 1.2% to 6.1% of patients [8][9][10][11][12][13][14][15] . Our perforation rate (8.2%) was slightly higher than in the other studies.…”

Section: Clinical Course In Patients With Perforationmentioning

confidence: 99%

“…According to a recent meta-analysis, although ESD had higher en bloc and curative resection rates than endoscopic mucosal resection (EMR), operation time was longer, with higher risks of complications compared to EMR [7] . Previous reports showed that large tumor size, location of the lesion in an upper region of the stomach, and long procedure time are risk factors for perforation following ESD [8][9][10][11][12][13] . Although perforation may be the most serious complication in the ESD procedure, most studies have reported recovery from perforation with conservative management such as endoscopic clipping, fasting, nasogastric aspiration, and broad-spectrum antibiotics [1,14] .…”

Section: Introductionmentioning

confidence: 99%

“…Although perforation may be the most serious complication in the ESD procedure, most studies have reported recovery from perforation with conservative management such as endoscopic clipping, fasting, nasogastric aspiration, and broad-spectrum antibiotics [1,14] . However, the previous reports regarding clinical outcomes of perforation during ESD are retrospective analyses [5,8,9,[13][14][15] . More recently, prospective studies by Onogi et al [16] and our group [17] found that "transmural air leak" or "silent" free air without endoscopically visible perforation detected only by computed tomography (CT) did not affect the post-ESD clinical course.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

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

Watari

Tomita²,

Toyoshima³

et al. 2013

WJGE

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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),

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Section: Clinical Course In Patients With Perforationsupporting

confidence: 92%

Section: Clinical Course In Patients With Perforationmentioning

confidence: 99%

Section: Clinical Course In Patients With Perforationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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

Watari

Tomita²,

Toyoshima³

et al. 2013

WJGE

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Complications of Endoscopic Mucosal Resection (EMR) and Endoscopic Submucosal Dissection (ESD)

Oda

Suzuki

Abe

2015

Gastrointestinal Emergencies

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Recent approach for preventing complications in upper gastrointestinal endoscopic submucosal dissection

et al. 2021

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Although endoscopic submucosal dissection (ESD) is a minimally invasive treatment method for upper gastrointestinal (GI) tumors, patients undergoing upper GI ESD sometimes fall into a serious condition from complications. Thus, it is important to fully understand how to prevent complications when performing upper GI ESD. One of the major complications in esophageal and gastric ESD is intraoperative perforation. To prevent this complication, blind dissection should be avoided. Traction‐assisted ESD is a useful technique for maintaining good endoscopic view. This method was proven to reduce the incidence of intraoperative perforation, which would become a standard technique in esophageal and gastric ESD. In gastric ESD, delayed bleeding is the most common complication. Recently, a novel prediction model (BEST‐J score) consisting of 10 factors with four risk categories for delayed bleeding in gastric ESD was established, and a free mobile application is now available. For reducing delayed bleeding in gastric ESD, vonoprazan ≥20 mg/day is the sole reliable method in the current status. Duodenal ESD is still challenging with a much higher frequency of complications, such as perforation and delayed bleeding, than ESD in other organs. However, with the development of improved devices and techniques, the frequency of complications in duodenal ESD has been decreasing. To prevent intraoperative perforation, some ESD techniques, such as using the distal tips of the Clutch Cutter, were developed. An endoscopic mucosal defect closure technique would be mandatory for preventing delayed complications. However, several unresolved issues, including standardization of duodenal ESD, remain and further studies are demanded.

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Risk factors for complications of endoscopic submucosal dissection in gastric tumors: analysis of 478 lesions

Cited by 147 publications

References 39 publications

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

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

Complications of Endoscopic Mucosal Resection (EMR) and Endoscopic Submucosal Dissection (ESD)

Recent approach for preventing complications in upper gastrointestinal endoscopic submucosal dissection

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