Retrospective Cohort Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 21, 2017; 23(3): 478-485
Published online Jan 21, 2017. doi: 10.3748/wjg.v23.i3.478
Risk factors for intraoperative perforation during endoscopic submucosal dissection of superficial esophageal squamous cell carcinoma
Masaaki Noguchi, Tomonori Yano, Tomoji Kato, Tomohiro Kadota, Maomi Imajoh, Hiroyuki Morimoto, Shozo Osera, Atsushi Yagishita, Tomoyuki Odagaki, Yusuke Yoda, Yasuhiro Oono, Hiroaki Ikematsu, Kazuhiro Kaneko
Masaaki Noguchi, Tomonori Yano, Tomoji Kato, Tomohiro Kadota, Maomi Imajoh, Hiroyuki Morimoto, Shozo Osera, Atsushi Yagishita, Tomoyuki Odagaki, Yusuke Yoda, Yasuhiro Oono, Hiroaki Ikematsu, Kazuhiro Kaneko, Department of Gastroenterology, Endoscopy division, National Cancer Center Hospital East, Chiba 277-8577, Japan
Masaaki Noguchi, Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo 105-8461, Japan
Author contributions: Noguchi M and Yano T designed the concept of the study, analyzed the data, and wrote the manuscript; Noguchi M, Yano T, Kato T, Kadota T, Imajoh M, Morimoto H, Osera S, Yagishita A, Odagaki T, Yoda Y, Oono Y, Ikematsu H and Kaneko K collected the data and reviewed the manuscript.
Institutional review board statement: This study was conducted in accordance with the principles of the Declaration of Helsinki, and was reviewed ethically and approved by Institutional Review Board of National Cancer Center Hospital (2014-119).
Informed consent statement: Patient informed consent was waived due to the retrospective design of the study.
Conflict-of-interest statement: Authors declare no conflict of interest relevant to this article.
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: Tomonori Yano, MD, Department of Gastroenterology, Endoscopy Division, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba 277-8577, Japan. toyano@east.ncc.go.jp
Telephone: +81-4-71331111 Fax: +81-4-7131-4724
Received: September 16, 2016
Peer-review started: September 18, 2016
First decision: October 10, 2016
Revised: October 26, 2016
Accepted: November 15, 2016
Article in press: November 16, 2016
Published online: January 21, 2017
Abstract
AIM

To identify the risk factors and clarify the subsequent clinical courses.

METHODS

This study retrospectively analyzed consecutive patients with esophageal squamous cell carcinoma (ESCC) treated using endoscopic submucosal dissection (ESD) between April 2008 and October 2012. We divided the ESCC lesions into perforation cases and non-perforation cases, and compared characteristics and endoscopic findings between the two groups. "Intraoperative perforation" was defined as the detection of a perforation site during ESD and the presence of mediastinal emphysema.

RESULTS

In total, 147 patients with 156 ESCC lesions were treated by ESD. Intraoperative perforation was recorded for nine lesions (5.8%) from nine patients. Multivariate analysis identified mucosal deficiency larger than 75% of the circumference of the esophagus as an independent risk factor for intraoperative perforation (OR = 7.37, 95%CI: 1.45-37.4, P = 0.016). The predominant site of perforation was the left wall [6/9 (67%)]. Six of nine perforation sites were successfully closed by clips during the procedures. Two of nine cases required drainage for pleural effusions; however, all nine cases recovered with conservative treatment and without surgical intervention. At the median follow up of 42 mo after ESD, no cases of local recurrence or distant organ metastasis had been observed.

CONCLUSION

This study suggests that mucosal deficiency larger than 75% of the luminal circumference is a risk factor for intraoperative perforation during ESD for ESCC.

Keywords: Endoscopic submucosal dissection, Risk factor, Esophageal carcinoma, Perforation

Core tip: Perforation is the major complication during endoscopic submucosal dissection (ESD), with a frequency of 0%-6.9%. The risk factors for intraoperative perforation during ESD for esophageal squamous cell carcinoma (ESCC) are largely unknown. In this study, we assessed the differences in perforation and non-perforation groups regarding the characteristics and endoscopic findings. Mucosal deficiency larger than 75% of the luminal circumference was a risk factor for intraoperative perforation during ESD for ESCC.