• Jiro Watari, Toshihiko Tomita, Fumihiko Toyoshima, Jun Sakurai, Takashi Kondo, Haruki Asano, Takahisa Yamasaki, Takuya Okugawa, Junji Tanaka, Takashi Daimon, Tadayuki Oshima, Hirokazu Fukui, Kazutoshi Hori, Takayuki Matsumoto, and Hiroto Miwa.
• Division of Upper Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan.
• Gastrointest. Endosc. 2012 Dec 1; 76 (6): 1116-23.

BackgroundAlthough endoscopic submucosal dissection (ESD) is feasible as a treatment for early gastric cancer, it requires great skill to perform and may place patients at increased risk of a number of complications, including perforation and aspiration pneumonia.ObjectiveTo investigate the incidence of "silent" free air without endoscopic perforation and aspiration pneumonia detected by CT after ESD and risk factors for the development of these 2 conditions.DesignProspective cohort study.SettingSingle academic center.PatientsThis study involved 87 patients with a total of 91 malignancies.InterventionAll patients underwent chest and abdominal CT and blood biochemistry analysis before and 1 day after ESD.Main Outcome MeasurementsThe incidence of silent free air and aspiration pneumonia after ESD and the related risk factors.ResultsSilent free air was identified in 37.3% of patients without perforation. Tumor location (the upper portion of the stomach), the presence of a damaged muscular layer during ESD, and procedure time, but not specimen size, were significantly associated with silent free air (P = .006, P = .04, P = .02, and P = .53, respectively). According to the receiver-operating characteristic analysis, the resulting cutoff value of the procedure time for silent free air was 105 minutes (67.7% sensitivity, 65.4% specificity). Only procedure time (≥ 105 minutes) was an independent predictor of silent free air development (odds ratio 3.23; 95% confidence interval, 1.21-8.64; P = .02). On the other hand, aspiration pneumonia was seen in 6.6% of patients. Silent free air and aspiration pneumonia did not affect hospitalization.LimitationsSingle center and small number of patients.ConclusionsSilent free air is frequently observed after ESD, and longer procedure time (≥ 105 minutes) was an independent risk factor for silent free air. However, silent free air and aspiration pneumonia detected by CT are not associated with clinically significant complications.Copyright © 2012 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

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