BACKGROUND: Although endoscopic submucosal dissection (ESD) is standard therapy for early gastric cancer, the complication rate is unsatisfactory, with perforation as the major complication during ESD. There have been several reports regarding the complications of ESD for gastric tumor especially perforation; however, little is known about the predictors for complications in patients undergoing ESD. The purpose of this retrospective study was to determine the risk factors for perforation in patients with early gastric cancer during ESD. METHODS: Between February 2003 and May 2010, we performed ESD for 1,289 lesions in 1,246 patients at six tertiary academic hospitals in Daegu, Kyungpook, Korea. Patient-related variables (age, sex, and underlying disease), endoscopic-related variables (indication of ESD, lesion size, location, type, and mucosal ulceration), procedure-related variables (operation time, complete resection, and invasion of submucosa/vessel/lymph node), and the pathologic diagnosis were evaluated as potential risk factors. RESULTS: The mean age of the patients was 64 years. The mean size of the endoscopic lesion was 19.4 mm. The overall en bloc resection rate was 93.3 %. Perforation (microperforation and macroperforation) was seen in 35 lesions. The location of the lesion (long axis: body/short axis: greater and lesser curvature) and piecemeal resection were associated with perforation (p = 0.01/0.047 and p = 0.049). Upon multivariate analysis, the location (body vs. antrum) of the lesion (odds ratio (OR) 2.636; 95 % confidence interval (CI) 1.319-5.267; p = 0.006) and piecemeal resection (OR 2.651; 95 % CI 1.056-6.656; p = 0.038) were significant predictive factors for perforation. CONCLUSIONS: The result of this study demonstrated that the location of the lesion (body) and piecemeal resection were related to perforation during ESD.
BACKGROUND: Although endoscopic submucosal dissection (ESD) is standard therapy for early gastric cancer, the complication rate is unsatisfactory, with perforation as the major complication during ESD. There have been several reports regarding the complications of ESD for gastric tumor especially perforation; however, little is known about the predictors for complications in patients undergoing ESD. The purpose of this retrospective study was to determine the risk factors for perforation in patients with early gastric cancer during ESD. METHODS: Between February 2003 and May 2010, we performed ESD for 1,289 lesions in 1,246 patients at six tertiary academic hospitals in Daegu, Kyungpook, Korea. Patient-related variables (age, sex, and underlying disease), endoscopic-related variables (indication of ESD, lesion size, location, type, and mucosal ulceration), procedure-related variables (operation time, complete resection, and invasion of submucosa/vessel/lymph node), and the pathologic diagnosis were evaluated as potential risk factors. RESULTS: The mean age of the patients was 64 years. The mean size of the endoscopic lesion was 19.4 mm. The overall en bloc resection rate was 93.3 %. Perforation (microperforation and macroperforation) was seen in 35 lesions. The location of the lesion (long axis: body/short axis: greater and lesser curvature) and piecemeal resection were associated with perforation (p = 0.01/0.047 and p = 0.049). Upon multivariate analysis, the location (body vs. antrum) of the lesion (odds ratio (OR) 2.636; 95 % confidence interval (CI) 1.319-5.267; p = 0.006) and piecemeal resection (OR 2.651; 95 % CI 1.056-6.656; p = 0.038) were significant predictive factors for perforation. CONCLUSIONS: The result of this study demonstrated that the location of the lesion (body) and piecemeal resection were related to perforation during ESD.
Authors: M Fujishiro; N Yahagi; N Kakushima; S Kodashima; Y Muraki; S Ono; K Kobayashi; T Hashimoto; N Yamamichi; A Tateishi; Y Shimizu; M Oka; K Ogura; T Kawabe; M Ichinose; M Omata Journal: Endoscopy Date: 2006-10 Impact factor: 10.093
Authors: Mindy J Hull; Mari Mino-Kenudson; Norman S Nishioka; Shinichi Ban; Alireza Sepehr; William Puricelli; Laura Nakatsuka; Shinichi Ota; Michio Shimizu; William R Brugge; Gregory Y Lauwers Journal: Am J Surg Pathol Date: 2006-01 Impact factor: 6.394
Authors: M Raithel; H Albrecht; W Scheppach; M Farnbacher; W Haupt; A F Hagel; V Schellerer; F Vitali; M F Neurath; H T Schneider Journal: Surg Endosc Date: 2016-09-15 Impact factor: 4.584
Authors: Keun Young Shin; Seong Woo Jeon; Kwang Bum Cho; Kyung Sik Park; Eun Soo Kim; Chang Keun Park; Yun Jin Chung; Joong Goo Kwon; Jin Tae Jung; Eun Young Kim; Kyeong Ok Kim; Byung Ik Jang; Si Hyung Lee; Jeong Bae Park; Chang Hun Yang Journal: Gut Liver Date: 2015-03 Impact factor: 4.519