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

Abstract

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. 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. 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±47.3min vs. 189.5±106.8min, p<0.05; 641.2±487.8 vs. 1,116±480.4mm(2), 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 900mm(2). The self-completion rate of ESD was decreased in cases with more than two predictive factors. 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.