title: Outcomes and predictive factors of "not self-completion" in gastric endoscopic submucosal dissection for novice operators.
abstract: BACKGROUND
  Endoscopic submucosal dissection (ESD) has become the standard endoscopic treatment for gastric neoplasms because of its safety and high rate of curability; however, it is not easy for novice operators to learn the technique of ESD. In this study, predictive factors of gastric neoplasms in which novices could not finish ESD by self-completion were evaluated.
  
  
  METHODS
  Eighty consecutive ESD procedures performed by four novice operators were retrospectively analyzed. Standard ESD procedures were performed using an insulation-tipped (IT) knife under supervision. Self-completion rates, procedure time, and complete resection rates were evaluated, and predictive factors for "not self-completion" were assessed.
  
  
  RESULTS
  The overall self-completion rate and en bloc plus R0 resection rate were 87.5% (70/80) and 95.7 % (67/70), respectively. In "not self-completion" cases (n = 10), the procedure time was longer and resected specimens were larger than those in self-completion cases (83.7 ± 47.3 min vs. 189.5 ± 106.8 min, p < 0.05; 641.2 ± 487.8 vs. 1,116 ± 480.4 mm(2), p < 0.01). Predictive factors of "not self-completion" were tumor location in the middle or upper third of the stomach or in the greater curvature and size of resected specimens larger than 900 mm(2). The self-completion rate of ESD was decreased in cases with more than two predictive factors.
  
  
  CONCLUSIONS
  For novice operators, tumor location and resected areas are predictive factors for failure to finish gastric ESD by self-completion. Selection of cancer lesions could be a key factor for effectiveness of ESD training.
authors.affiliation: Division of Endoscopy, Hokkaido University Hospital, Nishi-7, Kita-15, Kita-ku, Sapporo, 060-8638, Japan, onosho@med.hokudai.ac.jp.
authors.forename: Shouko
authors.initials: S
authors.lastname: Ono
authors.forename: Mototsugu
authors.initials: M
authors.lastname: Kato
authors.forename: Manabu
authors.initials: M
authors.lastname: Nakagawa
authors.forename: Aki
authors.initials: A
authors.lastname: Imai
authors.forename: Keiko
authors.initials: K
authors.lastname: Yamamoto
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Shimizu
mesh_terms: D000368:Aged; D057908:Argon Plasma Coagulation; D016063:Blood Loss, Surgical; D002983:Clinical Competence; D004210:Dissection / Q000379:methods; D005260:Female; D005753:Gastric Mucosa / Q000601:surgery*; D020699:Gastroscopes; D005773:Gastroscopy / Q000193:education / Q000379:methods*; D006488:Hemostasis, Surgical; D006801:Humans; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000601:surgery*; D020535:Video-Assisted Surgery / Q000193:education / Q000379:methods*
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