Efficacy of partial endoscopic submucosal dissection with polypectomy of gastric neoplasm during a learning period.

BACKGROUND/AIMS: This study evaluated the efficacy of partial endoscopic submucosal dissection (ESD) (snare polypectomy after nearly 70-90% of dissection on the final step) in the treatment of gastric neoplasm, especially when performed by clinicians in learning period.

METHODOLOGY

A total of 243 lesions from 205 patients were enrolled. One gastroenterologist who was beginner in ESD procedure performed ESD by hook knife. Complete resection rate, procedure time, en bloc resection rate, and complications between ESD and partial ESD groups.

RESULTS

Partial ESD was performed in 102 (42%) cases. No significant differences were observed between two groups in complete resection rate (95.1% vs. 90.1%), mean procedure time 71 +/- 63 vs. 66 +/- 46 minutes), observation of delayed bleeding (12.7% vs. 10.9%), and perforation (0.7% vs. 2.0%). En bloc resection rate was higher in ESD group (91.5% vs. 75.2%, p < 0.01) and immediate bleeding was more frequent in partial ESD group (39.4% vs. 57.4%, p = 0.01). However, ESD involving specimen size < or = 3 cm, difference was not seen in any of the variables. The complete resection rate was significantly improved after the physician performed more than 50 cases (p = 0.03).

CONCLUSIONS

Partial ESD method in the treatment of specimen size < or = 3 cm may improve the stability and feasibility of ESD, especially for inexperienced clinicians.