Analysis of Risk Factors for Postoperative Delayed Perforation Following Endoscopic Submucosal Dissection of...

Delayed perforation is a serious complication after endoscopic submucosal dissection (ESD) for gastrointestinal stromal tumors (GISTs). Understanding its incidence, associated risk factors, and clinical outcomes can guide preventative measures. This study aimed to determine the incidence of delayed perforation, identify independent risk factors, and describe the clinical course and management outcomes.

We retrospectively identified 57 patients who developed delayed perforation ("cases"). Each case was matched 1:1 by key variables (eg, age, tumor location) with 57 controls who did not experience delayed perforation. Baseline characteristics and the timing of delayed perforation were collected. We compared clinical and procedural factors in univariate analysis and conducted multivariate conditional logistic regression. Clinical course and management outcomes for delayed perforation, and subgroup analyses were assessed robustness.

A total of 57 patients developed delayed perforation at a median of 2 days postprocedure (IQR 1 to 7). In univariate analysis, larger tumor size ( P =0.02) and operator inexperience (<80 ESDs, P =0.03) were associated with an increased risk. In multivariate analysis, tumor size (adjusted OR 1.45 per cm, 95% CI: 1.04-2.02, P =0.03) and operator inexperience (adjusted OR 2.88, 95% CI: 1.21-6.81, P =0.02) remained significant risk factors. Most patients with delayed perforation presented with abdominal pain (61.4%), and diagnosis was primarily made via CT (66.7%). Management strategies included endoscopic closure (31.6%), surgical repair (35.1%), and conservative treatment (33.3%), with a mean hospital stay of 7.5±2.3 days. Sensitivity analyses confirmed the robustness of these findings.

Larger tumor size and limited operator experience were independent risk factors. Endoscopic or surgical interventions resulted in satisfactory outcomes. These results highlight the need for standardized preventive measures and operator training to mitigate this complication.