• J. Gastroenterol. Hepatol. · May 2012

    Risk factors for perforation and delayed bleeding associated with endoscopic submucosal dissection for early gastric neoplasms: analysis of 1123 lesions.

    • Tatsuya Toyokawa, Tomoki Inaba, Shizuma Omote, Akiko Okamoto, Rika Miyasaka, Kazuo Watanabe, Koichi Izumikawa, Joichiro Horii, Isao Fujita, Shigenao Ishikawa, Tamiya Morikawa, Takako Murakami, and Jun Tomoda.
    • Department of Gastroenterology, National Hospital Organization Fukuyama Medical Center, Fukuyama, Japan. toyotatu@kmail.plala.or.jp
    • J. Gastroenterol. Hepatol. 2012 May 1; 27 (5): 907-12.

    Background And AimEndoscopic submucosal dissection (ESD) is a useful procedure for the treatment of early gastric neoplasms; however, this advanced technique has also resulted in an increase in serious complications such as perforation and delayed bleeding. This study aimed to elucidate the risk factors for these complications.MethodsA total of 1123 lesions diagnosed with early gastric neoplasms and treated by ESD at three institutions were investigated. Retrospectively, patients with or without these complications were compared on the basis of the patient characteristics and treatment results.ResultsPerforation occurred in 27 lesions (2.4%) and delayed bleeding in 56 lesions (5.0%). Multivariate analysis indicated that lesions located in the upper area of the stomach (odds ratio [OR]: 4.88, 95% confidence interval [CI]: 2.21-10.75) was associated with a significantly higher risk of perforation, and that age ≥ 80 years (OR: 2.15, 95% CI: 1.18-3.90) and a long procedure time (OR: 1.01, 95% CI: 1.001-1.007) were associated with a significantly higher risk of delayed bleeding after ESD. The en bloc resection rate (74% vs 94%) and curative resection rate (48% vs 85%) of lesions with perforation were significantly lower than those without perforation. The rate of residual disease or recurrence after ESD was significantly higher in lesions with delayed bleeding than that without delayed bleeding (5.4% vs 0.84%).ConclusionsThis study demonstrated risk factors for perforation and delayed bleeding associated with ESD. Furthermore, it was clarified that perforation and delayed bleeding influenced post-procedure results and prognosis after ESD.© 2011 Journal of Gastroenterology and Hepatology Foundation and Blackwell Publishing Asia Pty Ltd.

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