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Gastroenterology Research and Practice
Volume 2017 (2017), Article ID 7404613, 8 pages
Research Article

Clinical Factors of Delayed Perforation after Endoscopic Submucosal Dissection for Gastric Neoplasms

1Department of Gastroenterology, Hyogo Cancer Center, Hyogo 673-8558, Japan
2Department of Internal Medicine, Kaibara hospital, Hyogo 669-3395, Japan

Correspondence should be addressed to Yoshinobu Yamamoto;

Received 28 May 2017; Revised 2 July 2017; Accepted 10 July 2017; Published 15 August 2017

Academic Editor: Tatsuya Toyokawa

Copyright © 2017 Yoshinobu Yamamoto et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background. Delayed perforation is a rare but severe complication of endoscopic submucosal dissection (ESD) for early gastric neoplasm (EGN). The aim of this study was to clarify clinical factors related to delayed perforation after ESD. Methods. A total of 1158 consecutive patients with 1199 EGNs underwent ESD at our hospital between January 2000 and December 2015. Univariate analysis was used to identify clinicopathological factors related to delayed perforation. Moreover, duration of cautery needed for hemostasis was measured by comparison between perforated and nonperforated points in patients with delayed perforation. Results. Delayed perforation occurred in 5 of 1158 consecutive patients with 1199 EGNs who underwent ESD (0.42%). All cases were diagnosed within 24 h after ESD and recovered with conservative management. On univariate analysis, location in the upper stomach was the factor most significantly associated with delayed perforation (). Duration of cautery needed for hemostasis was significantly longer at perforated points (9 s) than at nonperforated points (3.5 s) in five patients. Conclusions. Location in the upper stomach was the risk factor most prominently associated with delayed perforation after ESD for EGNs. In addition, delayed perforation appears associated with excessive electrocautery for hemostasis.