Perforation associated with endoscopic submucosal dissection for duodenal neoplasm without a papillary portion

Table 1 Clinical features and outcomes of patients with complications

Case	Age (yr)	Sex	Method	Complication	Clipping	Treatment	Hospital stay after ER (d)	Tumor characteristics
								Location	Size (mm)	Type
1	65	M	EMR	IP	Possible	Conservative	7	Post-ampulla	17	Is
2	60	M	EMR	IP	Possible	Conservative	6	Post-ampulla	9	IIa
3	55	M	ESD	DP	Possible	Surgical	12	Post-ampulla	24	IIa
4	60	M	ESD	Bleeding	Possible	Transfusion	9	Pre-ampulla	20	IIa
5	67	M	EMR	Bleeding	Possible	Hemostasis	11	Pre-ampulla	55	Isp
6	40	M	ESD	IP	Impossible	Surgical	11	Pre-ampulla	20	IIa
7	55	M	ESD	IP	Possible	Conservative	18	Pre-ampulla	13	IIc
8	64	M	ESD	IP	Impossible	Surgical	16	Post-ampulla	30	IIa
9	44	F	ESD	IP	Impossible	Surgical	12	Pre-ampulla	30	IIa
10	72	F	ESD	DP	Possible	Surgical	15	Pre-ampulla	40	IIa

ER: Endoscopic resection; EMR: Endoscopic mucosal resection; ESD: Endoscopic submucosal dissection; IP: Intraoperative perforation; DP: Delayed perforation.

Table 2 Predictors of perforation

		Perforation		P value
		Did not occur	Occurred
Sex	M	33	6
	F	18	2	0.704
Histological diagnosis	Adenoma	33	5
	Carcinoma	18	3	1.000
Tumor location	Pre-ampulla	31	4
	Post-ampulla	20	4	0.704
Tumor size	Under 20 mm	42	3
	Over 20 mm	9	5	0.014
Macroscopic type	Polyploid	11	1
	Superficial	40	7	0.482
Resection method	EMR	34	2
	ESD	17	6	0.047
Prophylactic clipping1	Not applied	10	0
	Applied	41	5	1.000

¹Excluded three cases in which clipping were impossible due to perforation. EMR: Endoscopic mucosal resection; ESD: Endoscopic submucosal dissection; M: Male; F: Female.