title: Procedure time of endoscopic submucosal dissection according to the size and location of early gastric cancers: analysis of 916 dissections performed by 4 experts.
abstract: 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.
  
  
  METHODS
  Retrospectively analyzed study of prospectively collected data.
  
  
  METHODS
  Tertiary care, academic medical center.
  
  
  METHODS
  Complete ESDs were performed by 4 experts, primarily using an insulated-tip knife, for 916 EGCs.
  
  
  METHODS
  ESD.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
authors.forename: Ji Yong
authors.initials: JY
authors.lastname: Ahn
authors.forename: Kee Don
authors.initials: KD
authors.lastname: Choi
authors.forename: Ji Young
authors.initials: JY
authors.lastname: Choi
authors.forename: Mi-Young
authors.initials: MY
authors.lastname: Kim
authors.forename: Jeong Hoon
authors.initials: JH
authors.lastname: Lee
authors.forename: Kwi-Sook
authors.initials: KS
authors.lastname: Choi
authors.forename: Do Hoon
authors.initials: DH
authors.lastname: Kim
authors.forename: Ho June
authors.initials: HJ
authors.lastname: Song
authors.forename: Gin Hyug
authors.initials: GH
authors.lastname: Lee
authors.forename: Hwoon-Yong
authors.initials: HY
authors.lastname: Jung
authors.forename: Jin-Ho
authors.initials: JH
authors.lastname: Kim
mesh_terms: D000368:Aged; D004210:Dissection / Q000295:instrumentation*; D042241:Early Diagnosis; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome