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Predictive risk factors of perforation in gastric endoscopic submucosal dissection for early gastric cancer: a large, multicenter study

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Abstract

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.

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References

  1. Soetikno R, Kaltenbach T, Yeh R, Gotoda T (2005) Endoscopic mucosal resection for early cancers of the upper gastrointestinal tract. J Clin Oncol 23:4490–4498

    Article  PubMed  Google Scholar 

  2. Fujishiro M, Yahagi N, Kakushima N, Kodashima S, Muraki Y, Ono S et al (2006) Successful nonsurgical management of perforation complicating endoscopic submucosal dissection of gastrointestinal epithelial neoplasms. Endoscopy 38:1001–1006

    Article  PubMed  CAS  Google Scholar 

  3. Takizawa K, Oda I, Gotoda T, Yokoi C, Matsuda T, Saito Y et al (2008) Routine coagulation of visible vessels may prevent delayed bleeding after endoscopic submucosal dissection: an analysis of risk factors. Endoscopy 40:179–183

    Article  PubMed  CAS  Google Scholar 

  4. Uedo N, Takeuchi Y, Yamada T, Ishihara R, Ogiyama H, Yamamoto S et al (2007) Effect of a proton pump inhibitor or an H2-receptor antagonist on prevention of bleeding from ulcer after endoscopic submucosal dissection of early gastric cancer: a prospective randomized controlled trial. Am J Gastroenterol 102:1610–1616

    Article  PubMed  CAS  Google Scholar 

  5. Oka S, Tanaka S, Kaneko I, Mouri R, Hirata M, Kawamura T et al (2006) Advantage of endoscopic submucosal dissection compared with EMR for early gastric cancer. Gastrointest Endosc 64:877–883

    Article  PubMed  Google Scholar 

  6. Oda I, Saito D, Tada M, Iishi H, Tanabe S, Oyama T et al (2006) A multicenter retrospective study of endoscopic resection for early gastric cancer. Gastric Cancer 9:262–270

    Article  PubMed  Google Scholar 

  7. Jeong G, Lee JH, Yu MK, Moon W, Rhee PL, Paik SW et al (2006) Nonsurgical management of microperforation induced by EMR of the stomach. Dig Liver Dis 38:605–608

    Article  PubMed  CAS  Google Scholar 

  8. Kojima T, Parra-Blanco A, Takahashi H, Fujita R (1998) Outcome of endoscopic mucosal resection for early gastric cancer: review of the Japanese literature. Gastrointest Endosc 48:550–554 discussion 554–555

    Article  PubMed  CAS  Google Scholar 

  9. Minami S, Gotoda T, Ono H, Oda I, Hamanaka H (2006) Complete endoscopic closure of gastric perforation induced by endoscopic resection of early gastric cancer using endoclips can prevent surgery (with video). Gastrointest Endosc 63:596–601

    Article  PubMed  Google Scholar 

  10. Gotoda T, Yanagisawa A, Sasako M, Ono H, Nakanishi Y, Shimoda T et al (2000) Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer 3:219–225

    Article  PubMed  Google Scholar 

  11. Jeon SW, Jung MK, Cho CM, Tak WY, Kweon YO, Kim SK et al (2009) Predictors of immediate bleeding during endoscopic submucosal dissection in gastric lesions. Surg Endosc 23:1974–1979

    Article  PubMed  Google Scholar 

  12. Hull MJ, Mino-Kenudson M, Nishioka NS, Ban S, Sepehr A, Puricelli W et al (2006) Endoscopic mucosal resection: an improved diagnosis procedure for early gastroesophageal epithelial neoplasms. Am J Surg Pathol 30:114–118

    Article  PubMed  Google Scholar 

  13. Ohkuwa M, Hosokawa K, Boku N, Ohtu A, Tajiri H, Yoshida S (2001) New endoscopic treatment for intramucosal gastric tumors using an insulated-tip diathermic knife. Endoscopy 33:221–226

    Article  PubMed  CAS  Google Scholar 

  14. Yamamoto H, Kawata H, Sunada K, Satoh K, Kaneko Y, Ido K, Sugano K (2002) Success rate of curative endoscopic mucosal resection with circumferential mucosal incision assisted by submucosal injection of sodium hyaluronate. Gastrointest Endosc 56:507–512

    Article  PubMed  Google Scholar 

  15. Gotoda T, Yamamoto H, Soetikno RM (2006) Endoscopic submucosal dissection of early gastric cancer. J Gastroenterol 41:929–942

    Article  PubMed  Google Scholar 

  16. Mannen K, Tsunada S, Hara M, Yamaguchi K, Sakata Y, Fujise T et al (2010) Risk factors for complications of endoscopic submucosal dissection in gastric tumors: analysis of 478 lesions. J Gastroenterol 45:30–36

    Article  PubMed  Google Scholar 

  17. Toyonaka T, Nishino E, Hirooka T, Ueda C, Noda K (2006) Intraoperative bleeding in endoscopic submucosal dissection in the stomach and strategy for prevention and treatment. Dig Endosc 18(Suppl 1):123–127

    Article  Google Scholar 

  18. Choi IJ, Kim CG, Chang HJ, Kim SG, Kook MC, Bae JM (2005) The learning curve for EMR with circumferential mucosal incision in treating intramucosal gastric neoplasm. Gastrointest Endosc 62:860–865

    Article  PubMed  Google Scholar 

  19. Gotoda T, Friedland S, Hamanaka H, Soetikno R (2005) A learning curve for advanced endoscopic resection. Gastrointest Endosc 62:866–867

    Article  PubMed  Google Scholar 

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Disclosures

Min Kim, Seong Woo Jeon, Kwang Bum Cho, Kyung Sik Park, Eun Soo Kim, Chang Keun Park, Hyang Eun Seo, Yun Jin Chung, Joong Goo Kwon, Jin Tae Jung, Eun Young Kim, Byeong Ik Jang, Si Hyung Lee, Kyeong Ok Kim, Chang Hun Yang have no commercial association that might be a conflict of interest in relation to this article.

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Authors and Affiliations

  1. Internal Medicine, Kyungpook National University School of Medicine, 50, Samduk 2-Ga, Chung-gu, Daegu, 700-721, South Korea

    Min Kim & Seong Woo Jeon

  2. Internal Medicine, Keimyung University School of Medicine, Daegu, South Korea

    Kwang Bum Cho, Kyung Sik Park & Eun Soo Kim

  3. Internal Medicine, Fatima Hospital, Daegu, South Korea

    Chang Keun Park, Hyang Eun Seo & Yun Jin Chung

  4. Internal Medicine, Daegu Catholic University School of Medicine, Daegu, South Korea

    Joong Goo Kwon, Jin Tae Jung & Eun Young Kim

  5. Internal Medicine, Youngnam University School of Medicine, Daegu, South Korea

    Byeong Ik Jang, Si Hyung Lee & Kyeong Ok Kim

  6. Internal Medicine, Dongkuk University School of Medicine, Gyeongju, South Korea

    Chang Hun Yang

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  1. Min Kim
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  2. Seong Woo Jeon
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  10. Jin Tae Jung
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  13. Si Hyung Lee
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Daegu-Kyungpook Gastrointestinal Study Group (DGSG)

Corresponding author

Correspondence to Seong Woo Jeon.

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Kim, M., Jeon, S.W., Cho, K.B. et al. Predictive risk factors of perforation in gastric endoscopic submucosal dissection for early gastric cancer: a large, multicenter study. Surg Endosc 27, 1372–1378 (2013). https://doi.org/10.1007/s00464-012-2618-4

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  • DOI: https://doi.org/10.1007/s00464-012-2618-4

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