Short‐term Outcomes of Endoscopic Submucosal Dissection (Esd) for Early Gastric Neoplasm: Multicenter Survey by Osaka University Esd Study Group

Akasaka, Tomofumi; Nishida, Tsutomu; Tsutsui, Shusaku; Michida, Tomoki; Yamada, Takuya; Ogiyama, Hideharu; Kitamura, Shinji; Ichiba, Makoto; Komori, Masato; Nishiyama, Osamu; Nakanishi, Fumihiko; Zushi, Shinichiro; Nishihara, Akihiro; Iijima, Hideki; Tsujii, Masahiko; Hayashi, Norio

doi:10.1111/j.1443-1661.2010.01062.x

Cited by 115 publications

(119 citation statements)

References 16 publications

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“…In the current study, a procedure time exceeding 115 min was considered to be a reliable marker associated with perforation development by ROC curve analysis. Thus, prolonged procedure time was a highly significant factor for endoscopic perforation; this finding is consistent with those of other studies [9,[11][12][13]16] . However, tumor location was not related to perforation.…”

Section: Clinical Course In Patients With Perforationsupporting

confidence: 82%

“…Indeed, only 8 of the patients in our study had perforation. In reports from Japan and South Korea, perforation was observed in 1.2% to 6.1% of patients [8][9][10][11][12][13][14][15] . Our perforation rate (8.2%) was slightly higher than in the other studies.…”

Section: Clinical Course In Patients With Perforationmentioning

confidence: 99%

“…In our previous study [17] , tumor location was also not an independent risk factor for silent free air. Previous studies showed that tumor location (the upper portion of the stomach) was a significant and independent predictor of perforation by multivariate analysis [8][9][10][11][12][13]16,17] . A possible explanation for the discrepancy may be the difference in the number of patients with perforation investigated between ours and other studies.…”

Section: Clinical Course In Patients With Perforationmentioning

confidence: 99%

“…According to a recent meta-analysis, although ESD had higher en bloc and curative resection rates than endoscopic mucosal resection (EMR), operation time was longer, with higher risks of complications compared to EMR [7] . Previous reports showed that large tumor size, location of the lesion in an upper region of the stomach, and long procedure time are risk factors for perforation following ESD [8][9][10][11][12][13] . Although perforation may be the most serious complication in the ESD procedure, most studies have reported recovery from perforation with conservative management such as endoscopic clipping, fasting, nasogastric aspiration, and broad-spectrum antibiotics [1,14] .…”

Section: Introductionmentioning

confidence: 99%

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

Watari

Tomita²,

Toyoshima³

et al. 2013

WJGE

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AIM:To evaluate clinical outcomes and risk factors for endoscopic perforation during endoscopic submucosal dissection (ESD) in a prospective study. METHODS:We investigated the clinical outcomes and risk factors for the development of perforation in 98 consecutive gastric neoplasms undergoing ESD regarding. Demographic and clinical parameters including patient-, tumor-, and treatment-related factors, clinical parameters, and duration of hospital stay were analyzed for risk factors for perforation. In subgroup analysis, we also compared the clinical outcomes between perforation and "silent" free air without endoscopically visible perforation detected only by computed tomography. RESULTS:Perforation was identified in 8.2% of patients. All patients were managed conservatively by the administration of antibiotics. The mean procedure time was significantly longer in patients with endoscopic perforation than in those without. According to the receiver-operating characteristic analysis, the resulting cutoff value of the procedure time for perforation was 115 min (87.5% sensitivity, 56.7% specificity). Prolonged procedure time (≥ 115 min) was associated with an increased risk of perforation (odds ratio 9.15; 95%CI: 1.08-77.54; P = 0.04). Following ESD, body temperature and C-reactive protein level were significantly higher in patients with perforation than in those without (P = 0.02), whereas there was no difference between these patient groups on the starting day of oral intake or of hospitalization. In subgroup analysis, the post-ESD clinical course was not different between endoscopic perforation and silent free air. CONCLUSION:Only prolonged procedure time (≥ 115 min) was significantly associated with perforation. The clinical outcomes of perforation are favorable and are comparable to those of patients with or without silent free air. Key words: Gastric cancer; Endoscopic submucosal dissection; Perforation; Risk factors; Treatment outcome Core tip: There has been little prospective study on the clinical outcomes of endoscopic perforation in endoscopic submucosal dissection for gastric neoplasia. In the current study, we investigated clinical outcomes of perforation during gastric endoscopic submucosal dissection, and analyzed various demographic and clinical parameters for risk factors. The results clearly demonstrated that prolonged procedure time (≥ 115 min),

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Section: Clinical Course In Patients With Perforationsupporting

confidence: 82%

Section: Clinical Course In Patients With Perforationmentioning

confidence: 99%

Section: Clinical Course In Patients With Perforationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Watari

Tomita²,

Toyoshima³

et al. 2013

WJGE

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show abstract

“…Additionally, a local recurrence may occur, with a reported incidence of approximately 10% [37] . The ESD-related complication rate is relatively low, based on a multicenter study of more than 1000 cases with gastric neoplasm [40] . ESD allows for a more secure resection of larger lesions [41,42] , resulting in a more accurate diagnosis because the margin of resected sample is larger than that for EMR.…”

Section: Focal Cancermentioning

confidence: 99%

Treatment strategy for gastric non-invasive intraepithelial neoplasia diagnosed by endoscopic biopsy

Nishida¹

2011

WJGP

Self Cite

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Treatment strategies, whether as follow-up or "total incisional biopsy" for gastric noninvasive intraepithelial neoplasia diagnosed by examination of an endoscopic forceps biopsy specimen, are controversial due to problems associated with the diagnostic accuracy of endoscopic forceps biopsy and questions about the safety and efficacy of endoscopic treatment. Based on the histological findings of the biopsy specimen, it is difficult to differentiate between reactive or regenerative changes, inflammation and neoplastic changes, intraepithelial and invasive tumors. Therefore, gastric neoplasia diagnosed as noninvasive intraepithelial often develop into invasive carcinoma during follow-up. Recent advances in endoscopic modalities and treatment devices, such as image-enhanced endoscopy and highfrequency generators, may make endoscopic treatment, such as endoscopic submucosal dissection (ESD), a therapeutic option for gastric intraepithelial neoplasia, including low-grade neoplasms. Future studies are required to evaluate whether ESD is a valid strategy for gastric intraepithelial neoplasm with regard to safety and cost effectiveness.

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Complications of Endoscopic Mucosal Resection (EMR) and Endoscopic Submucosal Dissection (ESD)

Oda

Suzuki

Abe

2015

Gastrointestinal Emergencies

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Short‐term Outcomes of Endoscopic Submucosal Dissection (Esd) for Early Gastric Neoplasm: Multicenter Survey by Osaka University Esd Study Group

Abstract: The incidence of pneumonia, but not perforation and bleeding, after ESD, is high in older patients (≥75years). Special care should be taken with older patients undergoing ESD to minimize the risk of postoperative pneumonia.

Cited by 115 publications

References 16 publications

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

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

Treatment strategy for gastric non-invasive intraepithelial neoplasia diagnosed by endoscopic biopsy

Complications of Endoscopic Mucosal Resection (EMR) and Endoscopic Submucosal Dissection (ESD)

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