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Risk factors for intraoperative perforation during endoscopic submucosal dissection of superficial esophageal

Masaaki Noguchi¹, Tomonori Yano¹, Tomoji Kato¹

¹Masaaki Noguchi, Tomonori Yano, Tomoji Kato, Tomohiro Kadota, Maomi Imajoh, Hiroyuki Morimoto, Shozo Osera, Atsushi Yagishita, Tomoyuki Odagaki, Yusuke Yoda, Yasuhiro Oono, Hiroaki Ikematsu, Kazuhiro Kaneko, Department of Gastroenterology, Endoscopy division, National Cancer Center Hospital East, Chiba 277-8577, Japan.

World Journal of Gastroenterology

|February 18, 2017

Abstract

Aim:

To identify the risk factors and clarify the subsequent clinical courses.

Methods:

This study retrospectively analyzed consecutive patients with esophageal squamous cell carcinoma (ESCC) treated using endoscopic submucosal dissection (ESD) between April 2008 and October 2012. We divided the ESCC lesions into perforation cases and non-perforation cases, and compared characteristics and endoscopic findings between the two groups. "Intraoperative perforation" was defined as the detection of a perforation site during ESD and the presence of mediastinal emphysema.

Results:

In total, 147 patients with 156 ESCC lesions were treated by ESD. Intraoperative perforation was recorded for nine lesions (5.8%) from nine patients. Multivariate analysis identified mucosal deficiency larger than 75% of the circumference of the esophagus as an independent risk factor for intraoperative perforation (OR = 7.37, 95%CI: 1.45-37.4, P = 0.016). The predominant site of perforation was the left wall [6/9 (67%)]. Six of nine perforation sites were successfully closed by clips during the procedures. Two of nine cases required drainage for pleural effusions; however, all nine cases recovered with conservative treatment and without surgical intervention. At the median follow up of 42 mo after ESD, no cases of local recurrence or distant organ metastasis had been observed.

Conclusion:

This study suggests that mucosal deficiency larger than 75% of the luminal circumference is a risk factor for intraoperative perforation during ESD for ESCC.

Keywords:

Endoscopic submucosal dissection Esophageal carcinoma Perforation Risk factor

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