Surgical Endoscopy

, Volume 27, Issue 10, pp 3577–3583

Outcomes and predictive factors of “not self-completion” in gastric endoscopic submucosal dissection for novice operators

  • Shouko Ono
  • Mototsugu Kato
  • Manabu Nakagawa
  • Aki Imai
  • Keiko Yamamoto
  • Yuichi Shimizu
Article

DOI: 10.1007/s00464-013-2929-0

Cite this article as:
Ono, S., Kato, M., Nakagawa, M. et al. Surg Endosc (2013) 27: 3577. doi:10.1007/s00464-013-2929-0

Abstract

Background

Endoscopic submucosal dissection (ESD) has become the standard endoscopic treatment for gastric neoplasms because of its safety and high rate of curability; however, it is not easy for novice operators to learn the technique of ESD. In this study, predictive factors of gastric neoplasms in which novices could not finish ESD by self-completion were evaluated.

Methods

Eighty consecutive ESD procedures performed by four novice operators were retrospectively analyzed. Standard ESD procedures were performed using an insulation-tipped (IT) knife under supervision. Self-completion rates, procedure time, and complete resection rates were evaluated, and predictive factors for “not self-completion” were assessed.

Results

The overall self-completion rate and en bloc plus R0 resection rate were 87.5% (70/80) and 95.7 % (67/70), respectively. In “not self-completion” cases (n = 10), the procedure time was longer and resected specimens were larger than those in self-completion cases (83.7 ± 47.3 min vs. 189.5 ± 106.8 min, p < 0.05; 641.2 ± 487.8 vs. 1,116 ± 480.4 mm2, p < 0.01). Predictive factors of “not self-completion” were tumor location in the middle or upper third of the stomach or in the greater curvature and size of resected specimens larger than 900 mm2. The self-completion rate of ESD was decreased in cases with more than two predictive factors.

Conclusions

For novice operators, tumor location and resected areas are predictive factors for failure to finish gastric ESD by self-completion. Selection of cancer lesions could be a key factor for effectiveness of ESD training.

Keywords

ESDGastric cancerLearning curve

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Shouko Ono
    • 1
  • Mototsugu Kato
    • 1
  • Manabu Nakagawa
    • 2
  • Aki Imai
    • 2
  • Keiko Yamamoto
    • 2
  • Yuichi Shimizu
    • 2
  1. 1.Division of EndoscopyHokkaido University HospitalSapporoJapan
  2. 2.Department of GastroenterologyHokkaido University Graduate School of MedicineSapporoJapan