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Stepwise training in rectal and colonic endoscopic submucosal dissection with differentiated learning curves.

Abstract：

BACKGROUND:Endoscopic submucosal dissection (ESD) has revolutionized the resection of GI superficial neoplasms, but adoption in Western countries is significantly delayed. OBJECTIVE:To evaluate a stepwise colorectal endoscopic submucosal dissection (ESD) learning and operative training protocol. DESIGN:Prospective study in the Western setting. SETTING:This study took place in a nonacademic hospital with one endoscopist expert in therapeutic endoscopy but novice in ESD. PATIENTS:Indications for ESD were superficial neoplasms 20 mm and larger without ulcerations or fibrosis. INTERVENTION:Training consisted of 5 unsupervised ESDs on isolated stomach, an observation period at an ESD expert Japanese center, 1 supervised ESD on isolated stomach, and retraining on 1 rectal ESD under supervision. The operative training on patients was performed without supervision moving from the rectum to the colon according to the competence achieved. MAIN OUTCOME MEASUREMENTS:Competence was defined as an 80% en bloc resection rate plus a statistically significant reduction in operating time per square centimeter. Learning curves were calculated based on consecutive blocks of 5 procedures. RESULTS:From February 2009 to February 2012, 30 rectal and 30 colonic ESDs were performed. The rectal ESD learning curve showed that the en bloc resection rate was 80% after 5 procedures (P = not significant); the operating time per square centimeter significantly decreased after 20 procedures (P = .0079); perforation occurred in 1 patient. The colonic ESD learning curve showed that the en bloc resection rate was 80% after 20 procedures (P = not significant); the operating time per square centimeter significantly decreased after 20 procedures (P = .031); perforations occurred in 2 patients. LIMITATIONS:Single-center design. CONCLUSIONS:A minimal intensive training seems sufficient for endoscopists expert in therapeutic procedures to take up ESD in a not overly arduous incremental method with separate and sequential learning curves for the rectum and colon.

journal_name

Gastrointest Endosc

journal_title

Gastrointestinal endoscopy

authors

Iacopini F,Bella A,Costamagna G,Gotoda T,Saito Y,Elisei W,Grossi C,Rigato P,Scozzarro A

doi

10.1016/j.gie.2012.08.024

subject

Has Abstract

pub_date

2012-12-01 00:00:00

pages

1188-96

issue

eissn

0016-5107

issn

1097-6779

pii

S0016-5107(12)02645-4

journal_volume

pub_type

临床试验,杂志文章

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Stepwise training in rectal and colonic endoscopic submucosal dissection with differentiated learning curves.