Published online Nov 28, 2015. doi: 10.3748/wjg.v21.i44.12635
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
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.
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.