Predictive factors of endoscopic submucosal dissection procedure time for gastric superficial neoplasia

Abstract

To identify the determinants of endoscopic submucosal dissection (ESD) operation time. This investigation was conducted as a single-center, prospective study in which ESD was performed by the same endoscopist at the Chinese PLA General Hospital. A total of 173 patients underwent ESD operations performed by Dr. Lu from July 2007 to December 2011, and 183 lesions were enrolled. Patient gender, age, tumor location, gross type, tumor size, pathological type and adhesions were recorded prospectively. The order of treatment represented the experience of the operator. Univariate analysis and multivariate analysis were performed to evaluate the relationships between these factors and ESD procedure time. Univariate analysis showed the ESD time was closely related to the gender (P = 0.0210), tumor size (P < 0.0001), location (P < 0.0001), gross type (P < 0.0001) and adhesion (P = 0.0010). The surgical proficiency level was associated with ESD time in unit area (P < 0.0001). Multivariate analysis revealed that the ESD time was positively correlated with tumor size (P < 0.0001), adhesion (P < 0.0001) and location (P < 0.0001), but negatively correlated with surgical proficiency level (P = 0.0046). Large tumor size, adjacency to the cardia, and adhesion are predictors of a long ESD time, whereas high surgical proficiency level predicts a short ESD time.