The incidence of "silent" free air and aspiration pneumonia detected by CT after gastric endoscopic submucosal dissection

Gastrointest Endosc. 2012 Dec;76(6):1116-23. doi: 10.1016/j.gie.2012.07.043.

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.

Publication types

  • Clinical Trial

MeSH terms

  • Adenocarcinoma / surgery*
  • Adenoma / surgery*
  • Aged
  • Aged, 80 and over
  • Cohort Studies
  • Female
  • Gastric Mucosa / surgery
  • Gastroscopy*
  • Humans
  • Incidence
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Operative Time
  • Pneumonia, Aspiration / diagnostic imaging
  • Pneumonia, Aspiration / epidemiology*
  • Pneumonia, Aspiration / etiology
  • Pneumoperitoneum / diagnostic imaging
  • Pneumoperitoneum / epidemiology*
  • Pneumoperitoneum / etiology
  • Postoperative Complications / diagnostic imaging
  • Postoperative Complications / epidemiology*
  • Postoperative Complications / etiology
  • Prospective Studies
  • ROC Curve
  • Risk Factors
  • Stomach / injuries
  • Stomach Neoplasms / surgery*
  • Tomography, X-Ray Computed
  • Treatment Outcome