The incidence of “silent” free air and aspiration pneumonia detected by CT after gastric endoscopic submucosal dissection

Watari, Jiro; Tomita, Toshihiko; Toyoshima, Fumihiko; Sakùrai, Jun; Kondo, Takashi; Asano, Haruki; Yamasaki, Takahisa; Okugawa, Takuya; Tanaka, Junji; Daimon, Takashi; Oshima, Tadayuki; Fukui, Hirokazu; Hori, Keiichi; Matsumoto, Takayuki; Miwa, Hiroto

doi:10.1016/j.gie.2012.07.043

Cited by 37 publications

(52 citation statements)

References 23 publications

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“…Recently in prospective studies, Onogi et al [16] and we reported that an "air leak" after gastric ESD, detected only by CT in patients without endoscopically visible perforation, was observed frequently, and this asymptomatic (silent) free air does not affect the post-ESD clinical course. Likewise, the current work, which is based on our recent study [17] , clearly demonstrated that perforation was not associated with clinically significant complications, and showed clinical outcomes similar to those of cases without perforafor perforation was 115 min (sensitivity, 87.5%; specificity, 56.7%) for patients who underwent gastric ESD.…”

Section: Discussionsupporting

confidence: 70%

“…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: 59%

“…However, the previous reports regarding clinical outcomes of perforation during ESD are retrospective analyses [5,8,9,[13][14][15] . More recently, prospective studies by Onogi et al [16] and our group [17] found that "transmural air leak" or "silent" free air without endoscopically visible perforation detected only by computed tomography (CT) did not affect the post-ESD clinical course. In contrast, there has been little prospective research regarding clinical outcomes of perforation during the ESD procedure.…”

Section: Introductionmentioning

confidence: 89%

“…The resulting cutoff value of the procedure time Subgroup analysis: Comparison of clinical outcomes between patients with perforation and those with silent free air All patients underwent plain abdominal CT on the day after ESD. If free air close to the stomach was detected by CT on the day after ESD even though no evidence of endoscopic perforation was seen during ESD and peritonitis, the case was defined as silent free air as reported previously [17] . We compared the clinical outcomes between patients with perforation and silent free air.…”

Section: Factors Predicting Development Of Endoscopic Perforationmentioning

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: Discussionsupporting

confidence: 70%

Section: Clinical Course In Patients With Perforationmentioning

confidence: 59%

Section: Introductionmentioning

confidence: 89%

Section: Factors Predicting Development Of Endoscopic Perforationmentioning

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

Self Cite

View full text Add to dashboard Cite

show abstract

“…We recently reported that asymptomatic free air detected by CT was frequently (37.3%) observed after ESD procedures even when no evidence of endoscopic perforation was seen during ESD (18). We thus speculate that this condition may not be associated with clinically significant complications.…”

Section: Discussionmentioning

confidence: 73%

Asymptomatic Free Air Caused by Mallory-Weiss Tears during Endoscopy

et al. 2015

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An 80-year-old woman was referred to our hospital for the treatment of advanced gastric cancer which extended from the antrum to the bulbus of the duodenum. Although the patient did not struggle or retch during endoscopy, multiple mucosal lacerations were observed in the proximal stomach by Mallory-Weiss tears. No evidence of perforation was identified at the sites. The day after endoscopy, computed tomography revealed free air close to the gastric cardia, but the patient did not complain of any symptoms; she was able to consume a normal diet and did not require any treatment.

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Massive pneumoperitoneum with abdominal pain and fever mimicking delayed perforation following endoscopic resection: A case report

Yeh

Chen

Hsu

et al. 2020

Adv in Digestive Medicine

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Pneumoperitoneum has been reported as an intraprocedural or acute postprocedural adverse event resulting from advanced endoscopic intervention. Here, we report a case of a massive pneumoperitoneum-mimicking delayed perforation after colonic endoscopic submucosal dissection. A 60-year-old man received endoscopic submucosal dissection for a large colon polyp. Room air was inadvertently used in the first half of the procedure. After 12 hours, the patient developed fever, abdominal pain, and bilateral shoulder pain, and massive pneumoperitoneum was detected through plain film and computed tomography. After urgent diagnostic paracentesis, the patient's symptoms dramatically improved, and laparotomy was avoided. Massive pneumoperitoneum rarely occurs in patients receiving complex and long-standing endoscopic procedures, and it may manifest similarly to delayed perforation. Prompt diagnostic paracentesis is valuable when the diagnosis is uncertain.

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The incidence of “silent” free air and aspiration pneumonia detected by CT after gastric endoscopic submucosal dissection

Cited by 37 publications

References 23 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

Asymptomatic Free Air Caused by Mallory-Weiss Tears during Endoscopy

Massive pneumoperitoneum with abdominal pain and fever mimicking delayed perforation following endoscopic resection: A case report

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