Introduction of gastric endoscopic submucosal dissection and skill acquisition in a regional hospital

Background and Aim: Endoscopic submucosal dissection (ESD) is standard treatment for early gastric cancer. With aging of the population in Japan being more pronounced in rural areas, the availability of ESD at regional hospitals is becoming important. Here, we assessed the learning curve of one physician for skill acquisition in gastric ESD. Methods: The subjects were 34 patients (38 lesions) who underwent gastric ESD at a regional hospital between October 2014 and March 2017 and 15 patients (15 lesions) who underwent the procedure at a university hospital between April 2017 and April 2018. The resection periods of the first 19 lesions and subsequent 19 lesions at the regional hospital were defined as the first and seconds periods, and the resection period of 15 lesions at the university hospital was defined as the third period. The learning curve across the three periods was assessed using the cumulative sum analysis method. Results: The resection speed in the first, second, and third periods were 6.4 +/- 4.1, 6.9 +/- 3.4, and 9.4 +/- 5.4 mm(2)/min, respectively (not significant). The slope of the learning curve began to increase at the 30th patient. The en bloc resection and curative resection rates did not differ significantly among the three periods. There were no serious procedure-related complications. Conclusion: This study showed that the introduction of gastric ESD at a regional hospital is possible, and that a certain skill level was acquired by the 30th patient. Furthermore, with careful patient selection, favorable results can be obtained and procedural safety ensured.