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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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Author(s)
Min KimSeong Woo JeonKwang Bum ChoKyung Sik ParkEun Soo KimChang Keun ParkHyang Eun SeoYun Jin ChungJoong Goo KwonJin Tae JungEun Young KimByeong Ik JangSi Hyung LeeKyeong Ok KimChang Hun YangDaegu-Kyungpook Gastrointestinal Study Group (DGSG)
Keimyung Author(s)
Cho, Kwang BumPark, Kyung SikKim, Eun Soo
Department
Dept. of Internal Medicine (내과학)
Journal Title
Surgical Endoscopy
Issued Date
2013
Volume
27
Issue
4
Keyword
Endoscopic submucosal dissectionPerforationEarly gastric cancer
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), procedurerelated
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.
Keywords Endoscopic submucosal dissection
Perforation Early gastric cancer more difficult and can result in more complications (particularly
perforation and bleeding) compared with conventional
EMR [2–6].
The perforation frequency is reported to be higher with
ESD (4 %) than with EMR (0.5 %) [7, 8]. This complication
has limited the use of ESD, although it provides en
bloc complete resection samples. Several recent studies
have shown that the recovery rate for patients who have
iatrogenic perforations associated with ESD treated conservatively
was the same as for patients without such
complications [2, 7, 9].
Although there have been several reports regarding the
complications of ESD for gastric tumor, especially perforation,
little is known about the predictors for complications
in patients undergoing ESD. In addition, no reports
have included multiple medical center studies. The purpose
of the present study was to determine the risk factors for
perforation in patients with early gastric cancer (EGC)
during ESD and to establish techniques to minimize these
complications through a multicenter study.
Keimyung Author(s)(Kor)
조광범
박경식
김은수
Publisher
School of Medicine
Citation
Min Kim et al. (2013). Predictive risk factors of perforation in gastric endoscopic submucosal dissection for early gastric cancer: a large, multicenter study. Surgical Endoscopy, 27(4), 1372–1378. doi: 10.1007/s00464-012-2618-4
Type
Article
ISSN
0930-2794
Source
https://link.springer.com/article/10.1007%2Fs00464-012-2618-4
DOI
10.1007/s00464-012-2618-4
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/34444
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
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