title: The learning curve for EMR with circumferential mucosal incision in treating intramucosal gastric neoplasm.
abstract: BACKGROUND
  EMR with circumferential mucosal incision facilitates en bloc resection, which is the most important predictor for complete resection in the treatment of intramucosal gastric neoplasm. The objective of the study was to evaluate the efficacy and the safety of EMR with circumferential mucosal incision in relation to the endoscopist's experience.
  
  
  METHODS
  In this retrospective study, we analyzed the outcome of 80 EMR procedures performed by a single endoscopist at the National Cancer Center, Goyang, Korea. The EMR procedure with circumferential mucosal incision was performed with a conventional needle knife. We compared the en bloc resection rate, the complete resection rate, the duration of the procedure time, and the associated complications by quartiles.
  
  
  RESULTS
  From the first to the last quartile, en bloc resection rates were 55%, 45%, 85%, and 85% (p = 0.006), and complete resection rates were 65%, 60%, 90%, and 85% (p = 0.039). The increase in the mean en bloc and complete resection rates between the first two quartiles and the second two quartiles was significant (p = 0.002 and p = 0.019, respectively). Three perforations (15%) were reported in the first quartile and only one (1.7%) in the remaining 3 quartiles (p = 0.046). The procedure time also decreased after the first 20 cases (p = 0.004).
  
  
  CONCLUSIONS
  For an experienced endoscopist, EMR with circumferential mucosal incision could be performed effectively and safely after the experience of 40 cases.
authors.affiliation: Center for Gastric Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, Korea.
authors.forename: Il Ju
authors.initials: IJ
authors.lastname: Choi
authors.forename: Chan Gyoo
authors.initials: CG
authors.lastname: Kim
authors.forename: Hee Jin
authors.initials: HJ
authors.lastname: Chang
authors.forename: Sang Gyun
authors.initials: SG
authors.lastname: Kim
authors.forename: Myeong-Cherl
authors.initials: MC
authors.lastname: Kook
authors.forename: Jae-Moon
authors.initials: JM
authors.lastname: Bae
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery; D002983:Clinical Competence; D005260:Female; D005753:Gastric Mucosa / Q000601:surgery*; D005773:Gastroscopy / Q000009:adverse effects / Q000379:methods; D006801:Humans; D007431:Intraoperative Complications; D007858:Learning; D008297:Male; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*