Risk factors for perforation and delayed bleeding associated with endoscopic submucosal dissection for early gastric neoplasms: Analysis of 1123 lesions
Risk factors for perforation and delayed bleeding associated with endoscopic submucosal dissection for early gastric neoplasms: Analysis of 1123 lesions
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DOI：
10.1111/j.1440-1746.2011.07039.x
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发表时间：
2012-05-01
影响因子：
4.1
通讯作者：
Tomoda, Jun
中科院分区：
文献类型：
--
作者：
Toyokawa, Tatsuya;Inaba, Tomoki;Tomoda, Jun
背景和目的：内镜粘膜下剥离术（ESD）是治疗早期胃肿瘤的有效方法;然而，这种先进的技术也导致严重并发症的增加，如穿孔和迟发性出血。本研究旨在阐明这些并发症的危险因素。方法：共1123个病变诊断为早期胃肿瘤和ESD治疗在三个机构进行了调查。根据患者的特征和治疗结果，对有或无这些并发症的患者进行了回顾性比较。结果：27个病灶（2.4%）发生穿孔，56个病灶（5.0%）发生迟发性出血。多因素分析表明，病变位于胃的上部区域，（比值比[OR]：4.88，95%置信区间[CI]：2.21-10.75）与穿孔风险显著升高相关，年龄≥ 80岁（OR：2.15，95% CI：1.18-3.90）和手术时间长（OR：1.01，95% CI：1.001-1.007）与ESD后迟发性出血的风险显著较高相关。穿孔组的肿瘤整块切除率（74%）和根治性切除率（48%）均明显低于无穿孔组（94%和85%）。ESD术后有延迟出血的病灶残留或复发率明显高于无延迟出血的病灶（5.4%比0.84%）。结论：本研究证实了与ESD相关的穿孔和迟发性出血的风险因素。此外，还阐明了穿孔和迟发性出血影响ESD后的术后结果和预后。
Background and Aim: Endoscopic submucosal dissection (ESD) is a useful procedure for the treatment of early gastric neoplasms; however, this advanced technique has also resulted in an increase in serious complications such as perforation and delayed bleeding. This study aimed to elucidate the risk factors for these complications. Methods: A total of 1123 lesions diagnosed with early gastric neoplasms and treated by ESD at three institutions were investigated. Retrospectively, patients with or without these complications were compared on the basis of the patient characteristics and treatment results. Results: Perforation occurred in 27 lesions (2.4%) and delayed bleeding in 56 lesions (5.0%). Multivariate analysis indicated that lesions located in the upper area of the stomach (odds ratio [OR]: 4.88, 95% confidence interval [CI]: 2.21-10.75) was associated with a significantly higher risk of perforation, and that age >= 80 years (OR: 2.15, 95% CI: 1.18-3.90) and a long procedure time (OR: 1.01, 95% CI: 1.001-1.007) were associated with a significantly higher risk of delayed bleeding after ESD. The en bloc resection rate (74% vs 94%) and curative resection rate (48% vs 85%) of lesions with perforation were significantly lower than those without perforation. The rate of residual disease or recurrence after ESD was significantly higher in lesions with delayed bleeding than that without delayed bleeding (5.4% vs 0.84%). Conclusions: This study demonstrated risk factors for perforation and delayed bleeding associated with ESD. Furthermore, it was clarified that perforation and delayed bleeding influenced post-procedure results and prognosis after ESD.