Risk Factors for Perforation with Endoscopic Mucosal Dissection

Tumor location in the upper stomach and tumor size >20 mm were predictors of perforation.


Endoscopic mucosal dissection (ESD) is now commonly used as therapy for early gastric cancers in countries with high prevalence. Bleeding and perforation are the most common potential complications. To identify predictors for perforation, investigators retrospectively studied ESD outcomes in 1500 patients in a single center in Japan.

Researchers identified 50 perforations during ESD of 1795 tumors (2.8%) from mid-2002 through 2010. Both univariate and multivariate analyses identified three predictors for perforation: tumor location in the upper stomach (perforation rate, 5.4%), tumor size >20 mm (perforation rate, 4.4%), and treatment during the early period — mid-2002 through mid-2007 — of documented procedures (perforation rate, 4.3%). Presence of an ulcer and the experience level of the endoscopist were not independent risk factors for perforation. Only three patients required emergency surgery. The rest were successfully treated with endoscopic clips.


Citation(s):

Ohta T et al. Factors predicting perforation during endoscopic submucosal dissection for gastric cancer. Gastrointest Endosc 2012 Jun; 75:1159.