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- Title
Delayed perforation: A hazardous complication of endoscopic resection for non-ampullary duodenal neoplasm.
- Authors
Inoue, Takuya; Uedo, Noriya; Yamashina, Takeshi; Yamamoto, Sachiko; Hanaoka, Noboru; Takeuchi, Yoji; Higashino, Koji; Ishihara, Ryu; Iishi, Hiroyasu; Tatsuta, Masaharu; Takahashi, Hidenori; Eguchi, Hidetoshi; Ohigashi, Hiroaki
- Abstract
Background Perforation is a major complication of endoscopic resection for gastrointestinal neoplasms. However, little is known about delayed perforation after endoscopic resection for non-ampullary duodenal neoplasm. The aim of the present study was to investigate the clinical features of delayed perforation after endoscopic resection for non-ampullary duodenal neoplasm. Patients and Methods This was a retrospective cohort study conducted in a referral cancer center. A total of 63 patients (41 with adenomas and 22 with carcinomas) underwent endoscopic mucosal resection ( EMR) or endoscopic submucosal dissection ( ESD) from January 1993 to December 2011. Incidence, outcome, and factors associated with occurrence of delayed perforation were investigated. Results Delayed perforation occurred in four patients (6.3%). All lesions were located distal to Vater's ampulla. Three of four delayed perforations occurred within 36 h after endoscopic resection. All patients developed retroperitonitis, and two also had retroperitoneal abscesses. Although three patients were cured with conservative management, a long hospital stay was required (28-, 80-, and 81-day hospital stay, respectively). One patient required emergency surgery as a result of panperitonitis. There was, fortunately, no mortality in this series. The significant predictors of delayed perforation were location (distal to Vater's ampulla, P = 0.007) and resection method ( ESD and piecemeal EMR, P = 0.003). Conclusion Endoscopic resection for non-ampullary duodenal neoplasms has a possible risk of morbid complication i.e. delayed perforation, especially in patients with lesions located on the side distal from the ampulla and who are treated with piecemeal EMR or ESD.
- Subjects
SURGICAL excision; TUMOR surgery; COHORT analysis; TISSUE wounds; ENDOSCOPY; DISEASE complications
- Publication
Digestive Endoscopy, 2014, Vol 26, Issue 2, p220
- ISSN
0915-5635
- Publication type
Article
- DOI
10.1111/den.12104