The learning curve for EMR with circumferential mucosal incision in treating intramucosal gastric neoplasm

Background: EMR with circumferential mucosal incision facilitates en bloc resection, which is the most important predictor for complete resection in the treatment of intramucosal gastric neoplasm. The objective of the study was to evaluate the efficacy and the safety of EMR with circumferential mucosal incision in relation to the endoscopist's experience. Methods: In this retrospective study, we analyzed the outcome of 80 EMR procedures performed by a single endoscopist at the National Cancer Center, Goyang, Korea. The EMR procedure with circumferential mucosal incision was performed with a conventional needle knife. We compared the en bloc resection rate, the complete resection rate, the duration of the procedure time, and the associated complications by quartiles. Results: From the first to the last quartile, en bloc resection rates were 55%, 45%, 85%, and 85% (p = 0.006), and complete resection rates were 65%, 60%, 90%, and 85% (P = 0.039). The increase in the mean en bloc and complete resection rates between the first two quartiles and the second two quartiles was significant (p = 0.002 and p = 0.019, respectively). Three perforations (15%) were reported in the first quartile and only one (1.7%) in the remaining 3 quartiles (p = 0.046). The procedure time also decreased after the first 20 cases (p = 0.004). Conclusions: For an experienced encloscopist, EMR with circumferential mucosal incision could be performed effectively and safely after the experience of 40 cases.