title: Impact of tumor location on clinical outcomes of gastric endoscopic submucosal dissection.
abstract: OBJECTIVE
  To determine whether there is a correlation between the location of the lesion and endoscopic submucosal dissection (ESD) outcome.
  
  
  METHODS
  From January 2008 to December 2010, ESD of 1443 gastric tumors was performed. En bloc resection rate, complete resection rate, procedure time and complication rate were analyzed according to the tumor location.
  
  
  RESULTS
  The rates of en bloc resection and complete resection were 91% (1318/1443) and 89% (1287/1443), respectively. The post-ESD bleeding rate was 4.3%, and perforation rate was 2.7%. Tumors located in the upper third of the stomach were associated with a longer procedure time and significantly higher rates of incomplete resection, piecemeal resection, and perforation than tumors below the upper third of the stomach. Posterior wall lesions had significantly longer procedure times and higher rates of incomplete resection and piecemeal resection than lesions in other locations. In multivariate analysis, posterior wall lesions and upper third lesions were significantly associated with incomplete resection and perforation, respectively. In post-ESD bleeding analysis, location was not a significant related factor.
  
  
  CONCLUSIONS
  More advanced endoscopic techniques are required during ESD for lesions located in the upper third or posterior wall of the stomach to decrease complications and improve therapeutic outcomes.
authors.affiliation: Ji Young Yoon, Choong Nam Shim, Sook Hee Chung, Wan Park, Hyunsoo Chung, Hyuk Lee, Sung Kwan Shin, Sang Kil Lee, Yong Chan Lee, Jun Chul Park, Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul 120-752, South Korea.
authors.forename: Ji Young
authors.initials: JY
authors.lastname: Yoon
authors.affiliation: Ji Young Yoon, Choong Nam Shim, Sook Hee Chung, Wan Park, Hyunsoo Chung, Hyuk Lee, Sung Kwan Shin, Sang Kil Lee, Yong Chan Lee, Jun Chul Park, Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul 120-752, South Korea.
authors.forename: Choong Nam
authors.initials: CN
authors.lastname: Shim
authors.affiliation: Ji Young Yoon, Choong Nam Shim, Sook Hee Chung, Wan Park, Hyunsoo Chung, Hyuk Lee, Sung Kwan Shin, Sang Kil Lee, Yong Chan Lee, Jun Chul Park, Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul 120-752, South Korea.
authors.forename: Sook Hee
authors.initials: SH
authors.lastname: Chung
authors.affiliation: Ji Young Yoon, Choong Nam Shim, Sook Hee Chung, Wan Park, Hyunsoo Chung, Hyuk Lee, Sung Kwan Shin, Sang Kil Lee, Yong Chan Lee, Jun Chul Park, Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul 120-752, South Korea.
authors.forename: Wan
authors.initials: W
authors.lastname: Park
authors.affiliation: Ji Young Yoon, Choong Nam Shim, Sook Hee Chung, Wan Park, Hyunsoo Chung, Hyuk Lee, Sung Kwan Shin, Sang Kil Lee, Yong Chan Lee, Jun Chul Park, Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul 120-752, South Korea.
authors.forename: Hyunsoo
authors.initials: H
authors.lastname: Chung
authors.affiliation: Ji Young Yoon, Choong Nam Shim, Sook Hee Chung, Wan Park, Hyunsoo Chung, Hyuk Lee, Sung Kwan Shin, Sang Kil Lee, Yong Chan Lee, Jun Chul Park, Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul 120-752, South Korea.
authors.forename: Hyuk
authors.initials: H
authors.lastname: Lee
authors.affiliation: Ji Young Yoon, Choong Nam Shim, Sook Hee Chung, Wan Park, Hyunsoo Chung, Hyuk Lee, Sung Kwan Shin, Sang Kil Lee, Yong Chan Lee, Jun Chul Park, Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul 120-752, South Korea.
authors.forename: Sung Kwan
authors.initials: SK
authors.lastname: Shin
authors.affiliation: Ji Young Yoon, Choong Nam Shim, Sook Hee Chung, Wan Park, Hyunsoo Chung, Hyuk Lee, Sung Kwan Shin, Sang Kil Lee, Yong Chan Lee, Jun Chul Park, Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul 120-752, South Korea.
authors.forename: Sang Kil
authors.initials: SK
authors.lastname: Lee
authors.affiliation: Ji Young Yoon, Choong Nam Shim, Sook Hee Chung, Wan Park, Hyunsoo Chung, Hyuk Lee, Sung Kwan Shin, Sang Kil Lee, Yong Chan Lee, Jun Chul Park, Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul 120-752, South Korea.
authors.forename: Yong Chan
authors.initials: YC
authors.lastname: Lee
authors.affiliation: Ji Young Yoon, Choong Nam Shim, Sook Hee Chung, Wan Park, Hyunsoo Chung, Hyuk Lee, Sung Kwan Shin, Sang Kil Lee, Yong Chan Lee, Jun Chul Park, Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul 120-752, South Korea.
authors.forename: Jun Chul
authors.initials: JC
authors.lastname: Park
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D004210:Dissection / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods*; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery*; D005773:Gastroscopy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018365:Neoplasm, Residual; D016017:Odds Ratio; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Complication; Endoscopic submucosal dissection; Gastric neoplasm; Location; Outcomes