title: Endoscopic submucosal dissection in gastric lesions: the 100 cases experience from a tertiary reference center in West.
abstract: OBJECTIVE
  Endoscopic submucosal dissection (ESD) is an endoscopic treatment method widely used in premalignant and malignant lesions in countries of the Far East. This method, which is difficult technically and has a high complication risk rate, has rarely been performed in the West, because of the fewer number of upper gastrointestinal lesions. In the present study, we aimed to present our results of gastric ESD procedures in respect to the learning curve.
  
  
  METHODS
  A total of 100 ESD procedures, which were performed in the stomach between April 2012 and September 2014, were recorded prospectively before and after the procedure. Patient data were analyzed retrospectively. ESD procedures were numbered chronologically; the first 30 patients constituted group 1, whereas the rest were classified as the group 2. ESD results were compared between the groups.
  
  
  RESULTS
  In a total of 95 patients, 100 gastric ESDs were performed. The overall en-bloc and complete resection rates were 93% and 92%, respectively. In respect of the learning curve, there were significant differences in the sizes of lesions and tissues obtained, procedure duration and dissection rate, snare use and knife preferences between groups (p = 0.002, p < 0.001, p = 0.003, p < 0.001, p = 0.009, and p < 0.001, respectively). No significant difference was detected in the en-bloc and complete resection rates and complications between the groups.
  
  
  CONCLUSIONS
  According to guideline recommendations and masters for ESD, if ESD training is initiated and continued, successful ESD may be performed in localized lesions in the stomach.
authors.affiliation: Department of Gastroenterology, Ataturk Training and Research Hospital, Katip Celebi University , Izmir , Turkey.
authors.forename: Fatih
authors.initials: F
authors.lastname: Aslan
authors.forename: Emrah
authors.initials: E
authors.lastname: Alper
authors.forename: Cem
authors.initials: C
authors.lastname: Cekıc
authors.forename: Derya Arslan
authors.initials: DA
authors.lastname: Yurtlu
authors.forename: Nese
authors.initials: N
authors.lastname: Ekıncı
authors.forename: Mahmut
authors.initials: M
authors.lastname: Arabul
authors.forename: Belkis
authors.initials: B
authors.lastname: Unsal
authors.forename: Yoshimasa
authors.initials: Y
authors.lastname: Mıura
authors.forename: Hironori
authors.initials: H
authors.lastname: Yamamoto
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004210:Dissection; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery*; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D062606:Tertiary Care Centers; D014421:Turkey
keywords: endoscopic submucosal dissection; gastric cancer; learning curve