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Comparative Study
. 2015 Nov 28;21(44):12635-43.
doi: 10.3748/wjg.v21.i44.12635.

Management and associated factors of delayed perforation after gastric endoscopic submucosal dissection

Haruhisa Suzuki  1 , Ichiro Oda  1 , Masau Sekiguchi  1 , Seiichiro Abe  1 , Satoru Nonaka  1 , Shigetaka Yoshinaga  1 , Takeshi Nakajima  1 , Yutaka Saito  1
Affiliations
Comparative Study

Management and associated factors of delayed perforation after gastric endoscopic submucosal dissection

Haruhisa Suzuki et al. World J Gastroenterol. .

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

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Figures

Figure 1
Figure 1
A superficial depressed early gastric cancer lesion located at the greater curvature of the upper gastric body of the gastric tube.
Figure 2
Figure 2
Mucosal defect just after the completion of endoscopic submucosal dissection (60 mm in size and half circumference).
Figure 3
Figure 3
A delayed perforation occurred 7 h after endoscopic submucosal dissection.
Figure 4
Figure 4
The delayed perforation was successfully closed using the endoloop-endoclip technique.
Figure 5
Figure 5
The delayed perforation had almost completely healed 15 d after endoscopic submucosal dissection.
See this image and copyright information in PMC

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