title: Can endoscopic submucosal dissection be safely performed in a smaller specialized clinic?
abstract: OBJECTIVE
  To investigate whether endoscopic submucosal dissection (ESD) can be safely performed at small clinics, such as the Shirakawa Clinic.
  
  
  METHODS
  One thousand forty-seven ESDs to treat gastrointestinal tumors were performed at the Shirakawa Clinic from April 2006 to March 2011. The efficacy, technical feasibility and associated complications of the procedures were assessed. The ESD procedures were performed by five endoscopists. Sedation was induced with propofol for esophagogastorduodenal ESD.
  
  
  RESULTS
  One thousand forty-seven ESDs were performed to treat 64 patients with esophageal cancer (E), 850 patients with gastric tumors (G: 764 patients with cancer, 82 patients with adenomas and four others), four patients with duodenal cancer (D) and 129 patients with colorectal tumors (C: 94 patients with cancer, 21 patients with adenomas and 14 others). The en bloc resection rate was 94.3% (E: 96.9%, G: 95.8%, D: 100%, C: 79.8%). The median operation time was 46 min (range: 4-360 min) and the mean size of the resected specimens was 18 mm (range: 2-150 mm). No mortal complications were observed in association with the ESD procedures. Perforation occurred in 12 cases (1.1%, E: 1 case, G: 9 cases, D: 1 case, C: 1 case) and postoperative bleeding occurred in 53 cases (5.1%, G: 51 cases, D: 1 case, C: 1 case); however, no case required either emergency surgery or blood transfusion. All of the perforations and postperative bleedings were resolved by endoscopic clipping or hemostasis. The other problematic complication observed was pneumonia, which was treated with conservative therapy.
  
  
  CONCLUSIONS
  ESD can be safely performed in a clinic with established therapeutic methods and medical services to address potential complications.
authors: Department of Endoscopy and Endoscopic Surgery, Shirakawa Clinic, Maebashi, Gunma 371-0051, Japan.
authors: Naondo
authors: N
authors: Sohara
authors: Satoshi
authors: S
authors: Hagiwara
authors: Riki
authors: R
authors: Arai
authors: Haruhisa
authors: H
authors: Iizuka
authors: Yasuhiro
authors: Y
authors: Onozato
authors: Satoru
authors: S
authors: Kakizaki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities; D004210:Dissection / Q000009:adverse effects / Q000379:methods*; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects; D005240:Feasibility Studies; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000473:pathology / Q000601:surgery*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D007564:Japan; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy; D015742:Propofol / Q000627:therapeutic use; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D006993:Hypnotics and Sedatives; D015742:Propofol
keywords: Clinic; Complication; Endoscopic submucosal dissection; Perforation
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