title: Is transnasal endoscope-assisted endoscopic submucosal dissection for gastric neoplasm useful in training beginners? A prospective randomized trial.
abstract: BACKGROUND
  The main problem in performing endoscopic submucosal dissection (ESD) of gastric neoplasms is that it is technically difficult, especially for beginners.
  
  
  METHODS
  A total of 51 patients were randomly assigned to undergo transnasal endoscope-assisted or routine ESD performed by two endoscopists inexperienced in ESD while supervised by one expert.
  
  
  RESULTS
  Total procedure time (p = 0.330), complete resection rate (p = 0.977), and complication rate (p = 0.157) were similar for the patients who underwent transnasal endoscope-assisted and routine ESD, but bleeding control time was significantly longer in the transnasal endoscope-assisted ESD group (p = 0.002). Three and six patients in the transnasal endoscope-assisted and routine ESD groups, respectively, were "dropped out" during the procedures (p = 0.291). The endoscopists tended to regard the traction with the transnasal endoscope as more useful for large tumors (p = 0.062). Bleeding control in patients who underwent the transnasal endoscope-assisted ESD was significantly longer for patients with tumors located in the anterior wall, posterior wall, and lesser curvature of the stomach (p = 0.001).
  
  
  CONCLUSIONS
  Transnasal endoscope-assisted ESD does not result in improved outcomes when performed by beginners, except for some large tumors. The traction method used by beginners was not superior to proper supervision and advice by an expert during ESD and allowing the expert to perform the procedure when the risk of complications is high or the procedure is delayed.
authors.affiliation: Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Asan Digestive Disease Research Institute, no. 388-1 Pungnap-2 dong, Songpa-gu, Seoul, 138-736, Korea. ji110@hanmail.net
authors.forename: Ji Yong
authors.initials: JY
authors.lastname: Ahn
authors.forename: Kee Don
authors.initials: KD
authors.lastname: Choi
authors.forename: Jeong Hoon
authors.initials: JH
authors.lastname: Lee
authors.forename: Ji Young
authors.initials: JY
authors.lastname: Choi
authors.forename: Mi-Young
authors.initials: MY
authors.lastname: Kim
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
authors.forename: Seunghee
authors.initials: S
authors.lastname: Baek
mesh_terms: D000236:Adenoma / Q000601:surgery*; D000368:Aged; D004210:Dissection / Q000379:methods; D005260:Female; D005753:Gastric Mucosa / Q000601:surgery*; D005773:Gastroscopy / Q000193:education* / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000193:education*; D009666:Nose; D011446:Prospective Studies; D013274:Stomach Neoplasms / Q000601:surgery*