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
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.