The incidence of "silent" free air and aspiration pneumonia detected by CT after gastric endoscopic submucosal dissection.
Gastrointest Endosc
; 76(6): 1116-23, 2012 Dec.
Article
in En
| MEDLINE
| ID: mdl-23164512
ABSTRACT
BACKGROUND:
Although endoscopic submucosal dissection (ESD) is feasible as a treatment for early gastric cancer, it requires great skill to perform and may place patients at increased risk of a number of complications, including perforation and aspiration pneumonia.OBJECTIVE:
To investigate the incidence of "silent" free air without endoscopic perforation and aspiration pneumonia detected by CT after ESD and risk factors for the development of these 2 conditions.DESIGN:
Prospective cohort study.SETTING:
Single academic center. PATIENTS This study involved 87 patients with a total of 91 malignancies. INTERVENTION All patients underwent chest and abdominal CT and blood biochemistry analysis before and 1 day after ESD. MAIN OUTCOME MEASUREMENTS The incidence of silent free air and aspiration pneumonia after ESD and the related risk factors.RESULTS:
Silent free air was identified in 37.3% of patients without perforation. Tumor location (the upper portion of the stomach), the presence of a damaged muscular layer during ESD, and procedure time, but not specimen size, were significantly associated with silent free air (P = .006, P = .04, P = .02, and P = .53, respectively). According to the receiver-operating characteristic analysis, the resulting cutoff value of the procedure time for silent free air was 105 minutes (67.7% sensitivity, 65.4% specificity). Only procedure time (≥ 105 minutes) was an independent predictor of silent free air development (odds ratio 3.23; 95% confidence interval, 1.21-8.64; P = .02). On the other hand, aspiration pneumonia was seen in 6.6% of patients. Silent free air and aspiration pneumonia did not affect hospitalization.LIMITATIONS:
Single center and small number of patients.CONCLUSIONS:
Silent free air is frequently observed after ESD, and longer procedure time (≥ 105 minutes) was an independent risk factor for silent free air. However, silent free air and aspiration pneumonia detected by CT are not associated with clinically significant complications.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Pneumonia, Aspiration
/
Pneumoperitoneum
/
Postoperative Complications
/
Stomach Neoplasms
/
Adenocarcinoma
/
Adenoma
/
Gastroscopy
Type of study:
Etiology_studies
/
Incidence_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Aged
/
Aged80
/
Female
/
Humans
/
Male
/
Middle aged
Language:
En
Journal:
Gastrointest Endosc
Year:
2012
Document type:
Article
Affiliation country:
Japan