Predictive risk factors of perforation in gastric endoscopic submucosal dissection for early gastric cancer: a large, mu
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Predictive risk factors of perforation in gastric endoscopic submucosal dissection for early gastric cancer: a large, multicenter study Min Kim • Seong Woo Jeon • Kwang Bum Cho • Kyung Sik Park • Eun Soo Kim • Chang Keun Park • Hyang Eun Seo • Yun Jin Chung • Joong Goo Kwon • Jin Tae Jung • Eun Young Kim • Byeong Ik Jang • Si Hyung Lee • Kyeong Ok Kim • Chang Hun Yang • Daegu-Kyungpook Gastrointestinal Study Group (DGSG) Received: 15 June 2012 / Accepted: 11 September 2012 / Published online: 13 December 2012 Ó Springer Science+Business Media New York 2012
Abstract Background Although endoscopic submucosal dissection (ESD) is standard therapy for early gastric cancer, the complication rate is unsatisfactory, with perforation as the major complication during ESD. There have been several reports regarding the complications of ESD for gastric tumor especially perforation; however, little is known about the predictors for complications in patients undergoing ESD. The purpose of this retrospective study was to determine the risk factors for perforation in patients with early gastric cancer during ESD. Methods Between February 2003 and May 2010, we performed ESD for 1,289 lesions in 1,246 patients at six tertiary academic hospitals in Daegu, Kyungpook, Korea. M. Kim S. W. Jeon (&) Internal Medicine, Kyungpook National University School of Medicine, 50, Samduk 2-Ga, Chung-gu, Daegu 700-721, South Korea e-mail: [email protected] K. B. Cho K. S. Park E. S. Kim Internal Medicine, Keimyung University School of Medicine, Daegu, South Korea C. K. Park H. E. Seo Y. J. Chung Internal Medicine, Fatima Hospital, Daegu, South Korea J. G. Kwon J. T. Jung E. Y. Kim Internal Medicine, Daegu Catholic University School of Medicine, Daegu, South Korea B. I. Jang S. H. Lee K. O. Kim Internal Medicine, Youngnam University School of Medicine, Daegu, South Korea C. H. Yang Internal Medicine, Dongkuk University School of Medicine, Gyeongju, South Korea
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Patient-related variables (age, sex, and underlying disease), endoscopic-related variables (indication of ESD, lesion size, location, type, and mucosal ulceration), procedurerelated variables (operation time, complete resection, and invasion of submucosa/vessel/lymph node), and the pathologic diagnosis were evaluated as potential risk factors. Results The mean age of the patients was 64 years. The mean size of the endoscopic lesion was 19.4 mm. The overall en bloc resection rate was 93.3 %. Perforation (microperforation and macroperforation) was seen in 35 lesions. The location of the lesion (long axis: body/short axis: greater and lesser curvature) and piecemeal resection were associated with perforation (p = 0.01/0.047 and p = 0.049). Upon multivariate analysis, the location (body vs. antrum) of the lesion (odds ratio (OR) 2.636; 95 % confidence interval (CI) 1.319–5.267; p = 0.006) and piecemeal resection (OR 2.651; 95 % CI 1.056–6.656; p = 0.038) were significant predictive factors for perforation. Conclusions The result of this s
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