title: Implementation of Endoscopic Submucosal Dissection for Gastric Lesions in Norway.
abstract: OBJECTIVE
  Endoscopic submucosal dissection is a minimal invasive method for an en bloc resection of dysplasia or early cancer in the stomach. It was developed in Japan in the 1990s, but thus far has not been widely adopted in Western countries. The aim of this study is to report from the introductory phase of gastric endoscopic submucosal dissection in a small-volume Scandinavian center.
  
  
  METHODS
  The 15 first patients operated on with endoscopic submucosal dissection in the stomach at the University Hospital of North Norway were consecutively registered in a prospective database and evaluated as a quality assurance study. The indications for the procedures were diagnostic or therapeutic.
  
  
  RESULTS
  Three patients had benign lesions, three had low-grade dysplasia, five had high-grade dysplasia, two had neuroendocrine tumors, and two had early gastric cancers (T1b). The R0 resection rate was 83%. One neuroendocrine tumor was directed to surgery. No recurrences have been detected after the median of 6 months, and with the exception of one delayed bleeding being treated endoscopically, no serious complications occurred. Two perforations were perioperatively closed with clips.
  
  
  CONCLUSIONS
  This is the first report on gastric endoscopic submucosal dissection in Scandinavia. Preliminary results from an introductory phase indicate that endoscopic submucosal dissection for dysplasia or early gastric cancer may be conducted safely and with acceptable results even in a small-volume center, assuming that surgeons and gastroenterologists in a region direct cases to one individual who can learn this skill.
authors.affiliation: Department of Gastrointestinal Surgery, Division of Surgery, Oncology and Women's Health, University Hospital of North Norway, Tromsø, Norway christian.rushfeldt@unn.no.
authors.forename: C
authors.initials: C
authors.lastname: Rushfeldt
authors.affiliation: Department of Cancer, Surgery and Transplant Surgery, Rikshospitalet, Oslo University Hospital, Oslo, Norway.
authors.forename: L
authors.initials: L
authors.lastname: Aabakken
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000069916:Endoscopic Mucosal Resection; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000473:pathology / Q000601:surgery*; D009664:Norway; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
keywords: Endoscopic submucosal dissection; dysplasia; early gastric cancer; endoscopic resection; gastric lesions; minimal invasive surgery