Original article
Clinical endoscopy
Procedure time of endoscopic submucosal dissection according to the size and location of early gastric cancers: analysis of 916 dissections performed by 4 experts

https://doi.org/10.1016/j.gie.2010.11.046Get rights and content

Background

Endoscopic submucosal dissection (ESD) is curative treatment for patients with early gastric cancer (EGC). Because of the technical difficulties, however, these procedures may take a long time, which can increase the rate of procedure-related complications.

Objective

To investigate the procedure time of ESD performed by 4 experts according to the location and size of the EGC.

Design

Retrospectively analyzed study of prospectively collected data.

Setting

Tertiary care, academic medical center.

Patients

Complete ESDs were performed by 4 experts, primarily using an insulated-tip knife, for 916 EGCs.

Intervention

ESD.

Main Outcome Measurement

Procedure time relative to the location and size of tumors was analyzed along with other predictive factors.

Results

ESD procedure time was increased as tumor size increased and for tumors in the middle and lower thirds of the stomach. Univariate analysis showed that tumor size, location, depth, submucosal fibrosis, and perforation during the procedure were significant predictors of procedure time. Multivariate analysis showed that proximal location, tumor size greater than 20 mm, submucosal fibrosis, and perforation during the procedure were independent predictors of a longer procedure time.

Limitation

Single-center, retrospective study design.

Conclusions

Procedure time became longer as tumor location became higher and as tumor size increased, except for tumors in the upper third of the stomach. These findings suggest that tumor size and location may be useful in predicting the time required to perform ESD.

Section snippets

Patients

From January 2005 to December 2008, 1766 gastric neoplasms in 1690 patients were treated by using ESD at Asan Medical Center, Seoul, South Korea. We retrospectively assessed the prospectively collected results of ESD performed on 916 lesions in 889 patients (714 men, 202 women; median age 64 years; interquartile range [IQR] 56-70 years). We excluded 755 lesions in 712 patients that were diagnosed as adenomas without a cancerous component; 91 lesions in 85 patients because they were treated by

Factors predictive of ESD procedure time

Of the 916 EGCs, 68 (7.4%) were located in the upper third of the stomach, 325 (35.5%) in the middle third, and 523 (57.1%) in the lower third. Median tumor size was 18 mm (IQR 12-28 mm). The tumors were divided into 5 groups by size. Other baseline patient characteristics and results of univariate analysis of variable factors are shown in Table 1. Tumor size, location, depth, submucosal fibrosis, and perforation during procedure were significantly associated or correlated with procedure time.

Discussion

Endoscopic treatment has become accepted in selected patients with EGC. ESD has been used for most endoscopic removals of tumors, with higher en bloc resection and complete resection rates, although its procedure time is longer and its complication rate is higher.9, 10, 11, 12, 13 Factors that may affect ESD procedure time include tumor location and size.4, 8, 14, 15 To our knowledge, however, no investigation of ESD procedure time according to tumor location and size has been performed in

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DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.

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Copyright © 2011 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.