title: Factors associated with the outcomes of endoscopic submucosal dissection in pyloric neoplasms.
abstract: BACKGROUND
  Pyloric neoplasms are one of the most technically difficult lesions to remove by endoscopic submucosal dissection (ESD).
  
  
  OBJECTIVE
  To evaluate the therapeutic outcomes of ESD in pyloric neoplasms according to clinicopathologic characteristics and to assess predictive factors for incomplete resection.
  
  
  METHODS
  A retrospective, single-center study.
  
  
  METHODS
  A total of 110 cases of pyloric adenomas and early cancers treated with ESD from January 2007 to May 2013 were included.
  
  
  METHODS
  ESD procedures with or without retroflexion maneuver were used in all qualifying cases.
  
  
  METHODS
  Therapeutic outcomes of ESD and procedure-related adverse events.
  
  
  RESULTS
  Complete resection rates differed significantly in relation to location (pylorus vs pylorus with duodenal extension, 79% vs 58%), directional distribution (upper hemisphere vs lower hemisphere of the pylorus, 67% vs 90%), tumor size (≤ 10 mm vs > 10 mm, 84% vs 67%), and circumferential extent of pyloric mucosal resection (≤ 1/2 vs > 1/2, 92% vs 62%). On multivariate analysis, tumor location (pylorus with duodenal extension; odds ratio 5.747), hemispheric distribution (upper hemisphere; odds ratio 4.906), and circumferential extent of resection (> 1/2; odds ratio 3.960) were independent factors associated with incomplete resection. The rates of procedure-related bleeding, stenosis, and perforation were 8%, 1%, and 1%, respectively; none of the adverse events required surgical intervention.
  
  
  CONCLUSIONS
  Single-center, retrospective study.
  
  
  CONCLUSIONS
  ESD is a safe, effective, and feasible treatment for pyloric neoplasms. However, the complete resection rate decreases for tumors that have duodenal extension, are located in the upper hemisphere, and have large circumferential extent of resection.
authors: Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.
authors: Jung Ho
authors: JH
authors: Bae
authors: Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.
authors: Gwang Ha
authors: GH
authors: Kim
authors: Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.
authors: Bong Eun
authors: BE
authors: Lee
authors: Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.
authors: Tae Kyun
authors: TK
authors: Kim
authors: Department of Pathology, Pusan National University School of Medicine, Busan, Korea.
authors: Do Youn
authors: DY
authors: Park
authors: Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.
authors: Dong Hoon
authors: DH
authors: Baek
authors: Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.
authors: Geun Am
authors: GA
authors: Song
mesh_terms: D000236:Adenoma / Q000473:pathology / Q000601:surgery*; D000368:Aged; D004210:Dissection; D004724:Endoscopy; D005260:Female; D005753:Gastric Mucosa; D006801:Humans; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual; D011708:Pylorus; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome