Clinical outcomes and risk factors for perforation in gastric endoscopic submucosal dissection: A prospective pilot study

Table 1 Relationship between perforation and various factors

	Control (n = 90)	Perforation (n = 8)	P value
Patient-related factors
Age (yr)	70.8 ± 9.2	72.4 ± 7.5	NS
Sex, male/female	69/21	6/2	NS
Active alcohol drinking Positive/negative	40/50	4/4	NS
Active smokingPositive/negative	16/74	2/6	NS
Body mass index (kg/m2)	23.2 ± 2.9	23.0 ± 3.3	NS
Tumor-related factors
Macroscopic type: I/IIa/II b/IIc	9/43/2/36	0/5/0/3	NS
Location: Upper/middle/ lower	12/48/30	2/6/0	NS
Scar: Positive/negative	9/81	0/8	NS
Depth of invasion: M/SM and beyond	77/13	5/3	NS
Histology: DAC/poorly DAC/adenoma	5/6/1979	7/1/0	NS
Treatment-related factors
Operator: Experienced/ less-experienced	32/58	2/6	NS
Resected dimensions (cm2)	9.7 ± 6.0	24.0 ± 24.9	NS
Procedure time (min)	122.5 ± 75.6	203.1 ± 114.3	0.02
Clinical parameters
Body temperature	36.9 ± 0.5	37.3 ± 0.6	NS
White blood cell (/mL)	10566.9 ± 2903.6	9898.8 ± 3149.4	NS
C-reactive protein (mg/dL)	1.5 ± 1.4	2.4 ± 1.3	0.04
Hospital stay (d)	10.5 ± 2.4	10.9 ± 1.5	NS

Data are expressed as mean ± SD. M: Intramucosal cancer and adenoma; SM: Submucosal invasive cancer; DAC: Differentiated-type adenocarcinoma; Poorly DAC: Poorly differentiated-type adenocarcinoma; NS: Not significant.

Table 2 Clinical courses after perforation

Age (yr)	Sex	Macroscopic type	Location	Depth of invasion	Scar	Resected dimensions (cm2)	Procedure time (min)	Nasogastric tube (d)	Beginning of oral intake after ESD (d)	Hospitalization (d)
62	Male	IIa	Upper	M	-	69.1	460	1	4	10
63	Male	IIc	Middle	M	-	5.5	130	-	3	10
77	Male	IIb +IIa	Middle	SM	-	18.8	220	1	3	11
71	Male	IIa	Middle	M	-	8.2	160	2	3	10
83	Female	IIc	Lower	SM	-	56.1	220	-	5	12
72	Female	IIa	Middle	M	-	22.0	215	-	3	10
80	Male	IIa	Upper	M	-	3.1	100	-	3	10
71	Male	IIc	Lower	SM	-	9.4	120	1	7	14

Data are expressed as mean ± SD. M: Intramucosal cancer and adenoma; SM: Submucosal invasive cancer; ESD: Endoscopic submucosal dissection.

Table 3 Subgroup analysis: Comparison in various factors between perforation and silent free air

	Perforation (n = 8)	Silent free air on CT (n = 35)	P value
Tumor-related factors
Location: Upper/middle/ lower	2/6/0	9/21/5	NS
Scar: Positive/negative	0/6	5/30	NS
Depth of invasion: M/SM and beyond	5/3	5/30	NS
Treatment-related factors
Operator: Experienced/ less-experienced	2/6	16/19	NS
Resected dimensions (cm2)	24.0 ± 24.9	10.4 ± 7.2	NS
Procedure time (min)	203.1 ± 114.3	145.1 ± 76.5	NS
Clinical parameters
Body temperature	37.3 ± 0.6	36.8 ± 0.6	0.04
White blood cell (/mm3)	9898.8 ± 3149.4	10658.0 ± 3119.3	NS
C-reactive protein (mg/dL)	2.4 ± 1.3	1.4 ± 1.0	0.03
Oral intake (d)	3.0	4.0 ± 1.5	NS
Hospital stay (d)	10.9 ± 1.5	10.7 ± 2.1	NS

Data are expressed as mean ± SD. CT: Computed tomography; M: Intramucosal cancer and adenoma; SM: Submucosal invasive cancer; NS: Not significant.