Department of Internal Medicine and Gastrointestinal Endoscopy, Saga Medical School, 5-1-1 Nabeshima, Saga 849-8501, Japan.
J Gastroenterol. 2010;45(1):30-6. doi: 10.1007/s00535-009-0137-4. Epub 2009 Sep 17.
Endoscopic submucosal dissection (ESD) technique has facilitated en bloc removal of widely spread lesions from the stomach. This retrospective study aimed to determine factors associated with serious complications of ESD.
Between December 2001 and March 2007, we have performed ESD for 478 lesions in 436 patients. We experienced 39 patients with post-operative bleeding and 17 patients with perforation. Risk factors of patients who received ESD in gastric mucosal tumors for complications were evaluated, focusing on resected size, location, scar lesions, operation time, and experience of endoscopists. We evaluated the patients' background characteristics including sex, age, body mass index (kg/m(2)), drug history of anticoagulant, and underlying diseases including cerebrovascular disorder, ischemic heart disease, liver dysfunction, renal dysfunction, hyperuricemia, hypertension and diabetes mellitus.
Multivariate analysis indicated a risk factor for perforation was long operation time. Multivariate analysis indicated a significant risk factor for post-operative bleeding was size of the resected tumor.
This study indicated risk factors for serious complications of ESD. Large resected tumor size was a risk factor for post-operative bleeding, while long operation time was a risk factor for perforation. Information regarding operation risk factors should be useful for planning strategies for ESD.
内镜黏膜下剥离术（ESD）技术有助于整块切除胃内广泛分布的病变。本回顾性研究旨在确定与 ESD 严重并发症相关的因素。
2001 年 12 月至 2007 年 3 月，我们对 436 例患者的 478 个病变进行了 ESD。我们有 39 例术后出血和 17 例穿孔患者。评估接受 ESD 治疗胃黏膜肿瘤患者的并发症相关风险因素，重点关注切除大小、位置、疤痕病变、手术时间和内镜医生的经验。我们评估了患者的背景特征，包括性别、年龄、体重指数（kg/m²）、抗凝药物史以及包括脑血管疾病、缺血性心脏病、肝功能障碍、肾功能障碍、高尿酸血症、高血压和糖尿病在内的基础疾病。
多变量分析表明，穿孔的危险因素是手术时间长。多变量分析表明，术后出血的显著危险因素是切除肿瘤的大小。
本研究表明了 ESD 严重并发症的危险因素。较大的切除肿瘤大小是术后出血的危险因素，而手术时间长是穿孔的危险因素。有关手术风险因素的信息对于 ESD 策略的制定将是有用的。
