title: The Feasibility of Performing Colorectal Endoscopic Submucosal Dissection Without Previous Experience in Performing Gastric Endoscopic Submucosal Dissection.
abstract: BACKGROUND
  Experience in gastric endoscopic submucosal dissection (ESD) has been suggested as a prerequisite for performing colorectal ESD by some experts.
  
  
  OBJECTIVE
  To evaluate the feasibility of performing colorectal ESD without experience in gastric ESD.
  
  
  METHODS
  Between November 2009 and December 2013, ESD was attempted for 250 colorectal lesions by an endoscopist having extensive colonoscopy experience but no prior experience of gastric ESD. All attempts were categorized according to the chronological order of procedures: group 1, attempts 1-50; group 2, attempts 51-100; group 3, attempts 101-150; group 4, attempts 151-200; and group 5, attempts 201-250. Procedure-related outcomes were analyzed.
  
  
  RESULTS
  En bloc resection rate ≥80% was achieved after initial ten ESD attempts. The ESD success rate (72, 80, 90, 90, and 94% in group 1-5, respectively; p for trend = 0.001), perforation rate (14, 14, 6, 6, and 0% in group 1-5, respectively; p for trend = 0.003), and macroperforation rate (6, 6, 2, 2, and 0% in group 1-5, respectively; p for trend = 0.042) improved as experience accumulated. Performing >100 ESDs, rectal location, and absence of submucosal fibrosis were independent predictors of successful procedure.
  
  
  CONCLUSIONS
  Colorectal ESD can be safely and effectively performed by an endoscopist having extensive experience in colonoscopy-related procedures even without previous experience of gastric ESD. Meticulous case selection for ESD novice and active supervision by expert endoscopists during the initial learning period may minimize the risk of perforation.
authors.affiliation: Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea.
authors.forename: Dong-Hoon
authors.identifier: http://orcid.org/0000-0001-7756-2704
authors.initials: DH
authors.lastname: Yang
authors.affiliation: Department of Internal Medicine, Yeosu Jeil Hospital, Yeosu, South Korea.
authors.forename: Gwi Hong
authors.initials: GH
authors.lastname: Jeong
authors.affiliation: Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea.
authors.forename: Yerim
authors.initials: Y
authors.lastname: Song
authors.affiliation: Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea.
authors.forename: Sang Hyoung
authors.initials: SH
authors.lastname: Park
authors.affiliation: Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea.
authors.forename: Soo-Kyung
authors.initials: SK
authors.lastname: Park
authors.affiliation: Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea.
authors.forename: Jong Wook
authors.initials: JW
authors.lastname: Kim
authors.affiliation: Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea.
authors.forename: Kee Wook
authors.initials: KW
authors.lastname: Jung
authors.affiliation: Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea.
authors.forename: Kyung-Jo
authors.initials: KJ
authors.lastname: Kim
authors.affiliation: Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea.
authors.forename: Byong Duk
authors.initials: BD
authors.lastname: Ye
authors.affiliation: Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea.
authors.forename: Seung-Jae
authors.initials: SJ
authors.lastname: Myung
authors.affiliation: Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea.
authors.forename: Suk-Kyun
authors.initials: SK
authors.lastname: Yang
authors.affiliation: Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea.
authors.forename: Jin-Ho
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
authors.forename: Young Soo
authors.initials: YS
authors.lastname: Park
authors.affiliation: Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea. jsbyeon@amc.seoul.kr.
authors.forename: Jeong-Sik
authors.initials: JS
authors.lastname: Byeon
mesh_terms: D000368:Aged; D002983:Clinical Competence; D003106:Colon / Q000601:surgery*; D003113:Colonoscopy / Q000009:adverse effects / Q000193:education / Q000379:methods*; D004210:Dissection / Q000009:adverse effects / Q000193:education / Q000379:methods*; D004503:Education, Medical, Graduate; D005240:Feasibility Studies; D005260:Female; D005753:Gastric Mucosa / Q000601:surgery*; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D007413:Intestinal Mucosa / Q000601:surgery*; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Colon; Endoscopic submucosal dissection; Rectum; Stomach