Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 28, 2015; 21(44): 12635-12643
Published online Nov 28, 2015. doi: 10.3748/wjg.v21.i44.12635
Management and associated factors of delayed perforation after gastric endoscopic submucosal dissection
Haruhisa Suzuki, Ichiro Oda, Masau Sekiguchi, Seiichiro Abe, Satoru Nonaka, Shigetaka Yoshinaga, Takeshi Nakajima, Yutaka Saito
Haruhisa Suzuki, Ichiro Oda, Masau Sekiguchi, Seiichiro Abe, Satoru Nonaka, Shigetaka Yoshinaga, Takeshi Nakajima, Yutaka Saito, Endoscopy Division, National Cancer Center Hospital, Tokyo 104-0045, Japan
Author contributions: Suzuki H and Oda I designed the study, analyzed and interpreted the data, and wrote the draft; Sekiguchi M, Abe S, Nonaka S, Yoshinaga S, Nakajima T, and Saito Y contributed to the critical revisions of the article for important intellectual content; all authors had final approval of this article.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: No conflict of interest was declared by the authors.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Haruhisa Suzuki, MD, Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan. harusuzu@ncc.go.jp
Telephone: +81-3-35422511-7794 Fax: +81-3-35423815
Received: May 25, 2015
Peer-review started: May 27, 2015
First decision: June 19, 2015
Revised: July 15, 2015
Accepted: September 30, 2015
Article in press: September 30, 2015
Published online: November 28, 2015
Processing time: 185 Days and 15.3 Hours
Abstract

AIM: To identify the actual clinical management and associated factors of delayed perforation after gastric endoscopic submucosal dissection (ESD).

METHODS: A total of 4943 early gastric cancer (EGC) patients underwent ESD at our hospital between January 1999 and June 2012. We retrospectively assessed the actual management of delayed perforation. In addition, to determine the factors associated with delayed perforation, after excluding 123 EGC patients with perforations that occurred during the ESD procedure, we analyzed the following clinicopathological factors among the remaining 4820 EGC patients by comparing the ESD cases with delayed perforation and the ESD cases without perforation: age, sex, chronological periods, clinical indications for ESD, status of the stomach, location, gastric circumference, tumor size, invasion depth, presence/absence of ulceration, histological type, type of resection, and procedure time.

RESULTS: Delayed perforation occurred in 7 (0.1%) cases. The median time until the occurrence of delayed perforation was 11 h (range, 6-172 h). Three (43%) of the 7 cases required emergency surgery, while four were conservatively managed without surgical intervention. Among the 4 cases with conservative management, 2 were successfully managed endoscopically using the endoloop-endoclip technique. The median hospital stay was 18 d (range, 15-45 d). There were no delayed perforation-related deaths. Based on a multivariate analysis, gastric tube cases (OR = 11.0; 95%CI: 1.7-73.3; P = 0.013) were significantly associated with delayed perforation.

CONCLUSION: Endoscopists must be aware of not only the identified factors associated with delayed perforation, but also how to treat this complication effectively and promptly.

Keywords: Early gastric cancer; Endoscopic submucosal dissection; Delayed perforation; Emergency surgery; Conservative management

Core tip: In this study, delayed perforation occurred in 0.1% (7 cases) of 4943 early gastric cancer patients undergoing endoscopic submucosal dissection (ESD); 43% (3 cases) of these cases required emergency surgery. This study also showed that the gastric tube was an independent risk factor associated with delayed perforation. This study is significant because it clarified both the clinical management and risk factors of delayed perforation based on data from a large series of consecutive patients undergoing ESD. Endoscopists must be aware of not only the identified factors associated with delayed perforation, but also how to treat this complication effectively and promptly.