Risk factors of perforation in gastric stromal tumors during endoscopic resection: a retrospective case–control study

Background and aims Perforation is a common complication during endoscopic resection (ER) of gastric gastrointestinal stromal tumors (gGISTs) associated with secondary infections, sepsis, hospitalization time and cost. However, the risk factors of perforation remain controversial. This study aimed to investigate the risk factors for perforation during ER of gGISTs. Methods This retrospective case–control study included consecutive patients with gGISTs who underwent ER between June 2009 and November 2021 at the Nanjing Drum Tower Hospital. Univariate and multivariate analyses were performed to investigate the risk factors for perforation. Sensitivity analyses with propensity scoring (PS) were performed to evaluate the stability of the independent effects. Results In total, 422 patients with gGISTs were included. The following factors were associated with perforation during ER: in the non-intraluminal growth patterns (all confounders adjusted odds ratio [aOR]: 5.39, 95% CI 2.99–9.72, P < 0.001), in the gastric fundus (aOR 2.25, 95% CI 1.40–3.60, P = 0.007), sized ≥ 2 cm (aOR 1.70, 95% CI 1.04–2.77, P = 0.035), in the lesser curvature (aOR 0.12, 95% CI 0.05–0.27, P < 0.001), and in the gastric cardia (aOR 0.13, 95% CI 0.04–0.50, P = 0.003). The PS analysis confirmed the stable independent effects of these identified risk factors. Conclusions ERs of gGISTs in non-intraluminal growth patterns, in the gastric fundus, and with larger tumor size were independent risk factors for perforation. While tumors in the lesser curvature or gastric cardia were independent protective factor for perforation.