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CC BY-NC-ND 4.0 · Endosc Int Open 2025; 13: a24517835
DOI: 10.1055/a-2451-7835
Original article

Improved outcomes of endoscopic treatment for delayed perforation following endoscopic submucosal dissection for gastric epithelial neoplasms

Daiki Kitagawa 
1   Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan (Ringgold ID: RIN53312)
2   Gastroenterology, Osaka Metropolitan University Graduate School of Medicine School of Medicine, Osaka, Japan (Ringgold ID: RIN12935)
,
Noriya Uedo 
1   Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan (Ringgold ID: RIN53312)
,
Noboru Hanaoka
3   Gastroenterology and Endoscopy, HANAOKA Gastroenterology and Endoscopy Clinic, Osaka, Japan
,
Takashi Kanesaka 
1   Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan (Ringgold ID: RIN53312)
,
Yasuhiro Tani
1   Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan (Ringgold ID: RIN53312)
,
Yuki Okubo
1   Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan (Ringgold ID: RIN53312)
,
Yuya Asada 
1   Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan (Ringgold ID: RIN53312)
,
Tomoya Ueda 
1   Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan (Ringgold ID: RIN53312)
,
Atsuko Kizawa
1   Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan (Ringgold ID: RIN53312)
,
Takehiro Ninomiya
1   Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan (Ringgold ID: RIN53312)
,
Yoshiaki Ando 
1   Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan (Ringgold ID: RIN53312)
,
Gentaro Tanabe
1   Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan (Ringgold ID: RIN53312)
,
Yuta Fujimoto
1   Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan (Ringgold ID: RIN53312)
,
Mori Hitoshi
1   Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan (Ringgold ID: RIN53312)
,
Minoru Kato
1   Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan (Ringgold ID: RIN53312)
,
Shunsuke Yoshii
1   Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan (Ringgold ID: RIN53312)
,
Satoki Shichijo
1   Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan (Ringgold ID: RIN53312)
,
Sachiko Yamamoto
1   Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan (Ringgold ID: RIN53312)
,
Koji Higashino
1   Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan (Ringgold ID: RIN53312)
,
Tomoki Michida
1   Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan (Ringgold ID: RIN53312)
,
Ryu Ishihara
1   Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan (Ringgold ID: RIN53312)
,
Yasuhiro Fujiwara
2   Gastroenterology, Osaka Metropolitan University Graduate School of Medicine School of Medicine, Osaka, Japan (Ringgold ID: RIN12935)
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Abstract

Background and study aims

Emergency surgery is usually required for patients with delayed perforation after gastric endoscopic submucosal dissection (ESD); however, cases of successful endoscopic treatment recently have been reported. Here, we elucidated the usefulness of endoscopic intervention for patients with delayed perforation.

Patients and methods

Patients who underwent gastric ESD from 2005 to 2022 were assessed for eligibility. Delayed perforation was defined as no intraprocedural perforation after the ESD but subsequent development of peritoneal irritation and free air on computed tomography scan. Participants were divided into early- and late-period groups based on time (October 2015) of implementation of the polyglycolic acid (PGA) sheet and the over-the-scope clip (OTSC) in clinical practice. We evaluated changes in incidence of required surgery.

Results

Among the 5,048 patients who underwent gastric ESD, delayed perforation occurred in 28 patients (0.6%, 95% confidence interval [CI] 0.4%-0.8%). Incidence of delayed perforation did not differ significantly between the early- and late-period groups (0.5% vs. 0.6%). The proportion of patients who underwent surgery was significantly smaller in the late-period group than in the early-period group (54% vs. 13%, odds ratio [OR] 0.14, 95% CI 0.02–0.83; P = 0.042); this was confirmed by multivariate analysis (adjusted OR 0.04, 95% CI 0.002–0.9; P = 0.043) after adjustment for age, sex, Charlson’s comorbidity index, tumor location, and size.

Conclusions

Endoscopic intervention using PGA sheets and OTSC was associated with a low incidence of required surgery for delayed perforation after gastric ESD and is recommended.

Keywords

Endoscopy Upper GI Tract - Endoscopic resection (ESD, EMRc, ...) - Precancerous conditions & cancerous lesions (dysplasia and cancer) stomach - Quality and logistical aspects - Performance and complications


Publication History

Received: 14 May 2024

Accepted after revision: 24 October 2024

Accepted Manuscript online:
11 December 2024

Article published online:
29 January 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Bibliographical Record
Daiki Kitagawa, Noriya Uedo, Noboru Hanaoka, Takashi Kanesaka, Yasuhiro Tani, Yuki Okubo, Yuya Asada, Tomoya Ueda, Atsuko Kizawa, Takehiro Ninomiya, Yoshiaki Ando, Gentaro Tanabe, Yuta Fujimoto, Mori Hitoshi, Minoru Kato, Shunsuke Yoshii, Satoki Shichijo, Sachiko Yamamoto, Koji Higashino, Tomoki Michida, Ryu Ishihara, Yasuhiro Fujiwara. Improved outcomes of endoscopic treatment for delayed perforation following endoscopic submucosal dissection for gastric epithelial neoplasms. Endosc Int Open 2025; 13: a24517835.
DOI: 10.1055/a-2451-7835
 

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