Influential factors in procedure time of endoscopic submucosal dissection for gastric cancer with fibrotic change

Background: Factors correlating with the technical difficulty of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) are still unclear. EGC coexisting with fibrosis inside lesions has been a common therapeutic indication for ESD. The aim of this study was to clarify the most important factor related to difficult ESD for EGC. Patients and Methods: Fifty‐six patients (49 male and seven female, median age 66 years) who received ESD at a single institute for EGC with fibrosis in the resected lesion were selected. Various clinicopathological factors, including the histological findings of fibrotic changes within the cancer area in the resected specimen, were evaluated statistically for correlation with ESD procedure time. Results: Univariate linear regression analysis with logarithmic ESD procedure time revealed the upper‐third portion of lesion in the stomach (P = 0.02), histological classification of dense fibrosis (ulcer/ulcer scar‐III/IV) within EGC (P < 0.001), and presence of peptic ulcer other than EGC (P = 0.04). Areas of the resected specimen (P < 0.001) and fibrosis (P < 0.001) were significant factors related to prolonged operation times. Multivariate analysis demonstrated that the upper‐third portion of lesion (P = 0.007), ulcer/ulcer scar‐III/IV findings (P = 0.006), and area of resected specimen (P = 0.006) were significant independent factors influencing ESD procedure time. Conclusion: Histological findings of fibrotic changes coexisting with EGC are closely related to technical difficulty in ESD as well as the location of tumors. Preoperative precise evaluation of fibrotic changes within EGC may be helpful to predict a technical difficulty in ESD.