Endoscopic Submucosal Dissection Skills Transfer to Clinical Practice after Hands-On Workshops: An International Survey.
Animal models
Endoscopic skills
Endoscopic submucosal dissection
Gastrointestinal endoscopy
Hands-on workshops
Simulation
Training
Journal
Digestive diseases (Basel, Switzerland)
ISSN: 1421-9875
Titre abrégé: Dig Dis
Pays: Switzerland
ID NLM: 8701186
Informations de publication
Date de publication:
2022
2022
Historique:
received:
24
06
2021
accepted:
23
11
2021
pubmed:
3
12
2021
medline:
8
9
2022
entrez:
2
12
2021
Statut:
ppublish
Résumé
Endoscopic submucosal dissection (ESD) is a complex procedure, requiring enhanced technical skills. Translation into clinical practice of ESD training programs has not been documented. Our aim was to assess ESD training pathways of endoscopists participating in dedicated workshops and its clinical impact on ESD outcomes. Participants of live porcine models ESD workshops, from 2013 to 2019, were included. They were invited to complete a survey focusing on human ESD performance after training, prior skills/competencies, complete learning pathway, and clinical outcomes. From 118 invited participants, 40 (34%) completed the questionnaire. Nineteen (47%) endoscopists performed human ESD after the workshop, predominantly male (89%). At the beginning of human ESD, endoscopists had a mean of 7.7 (standard deviation (SD) 4.1) years of endoscopic experience and were all performing endoscopic mucosal resection (and emergency endoscopy. Before ESD practice, 100% of the participants were trained with live animal models and 68% with ex vivo models. The majority started clinical ESD in the lower third of the stomach or rectum (90%), with lesions ≤30 mm (89%). Each endoscopist performed a median of 19 (interquartile range 8-32) cumulative ESDs, over a mean of 3.9 (SD 2.0) years. Total en bloc resection rate was 92%, R0 resection rate 88%, and curative resection rate 86%, whereas adverse events remained <10%. Endoscopists with >10 human ESD procedures achieve clinical competence thresholds. Participants of ESD workshops are adequately skilled prior to clinical ESD, complying with recommendations for training and properly implementing the technique. Transfer to clinical practice, of prior ESD skills obtained in hands-on training courses, was documented. Structured training programs achieve clinical outcomes exceeding established standards, namely in the very initial clinical phase.
Sections du résumé
BACKGROUND
BACKGROUND
Endoscopic submucosal dissection (ESD) is a complex procedure, requiring enhanced technical skills. Translation into clinical practice of ESD training programs has not been documented. Our aim was to assess ESD training pathways of endoscopists participating in dedicated workshops and its clinical impact on ESD outcomes.
METHODS
METHODS
Participants of live porcine models ESD workshops, from 2013 to 2019, were included. They were invited to complete a survey focusing on human ESD performance after training, prior skills/competencies, complete learning pathway, and clinical outcomes.
RESULTS
RESULTS
From 118 invited participants, 40 (34%) completed the questionnaire. Nineteen (47%) endoscopists performed human ESD after the workshop, predominantly male (89%). At the beginning of human ESD, endoscopists had a mean of 7.7 (standard deviation (SD) 4.1) years of endoscopic experience and were all performing endoscopic mucosal resection (and emergency endoscopy. Before ESD practice, 100% of the participants were trained with live animal models and 68% with ex vivo models. The majority started clinical ESD in the lower third of the stomach or rectum (90%), with lesions ≤30 mm (89%). Each endoscopist performed a median of 19 (interquartile range 8-32) cumulative ESDs, over a mean of 3.9 (SD 2.0) years. Total en bloc resection rate was 92%, R0 resection rate 88%, and curative resection rate 86%, whereas adverse events remained <10%. Endoscopists with >10 human ESD procedures achieve clinical competence thresholds.
CONCLUSIONS
CONCLUSIONS
Participants of ESD workshops are adequately skilled prior to clinical ESD, complying with recommendations for training and properly implementing the technique. Transfer to clinical practice, of prior ESD skills obtained in hands-on training courses, was documented. Structured training programs achieve clinical outcomes exceeding established standards, namely in the very initial clinical phase.
Identifiants
pubmed: 34856553
pii: 000521274
doi: 10.1159/000521274
pmc: PMC9501745
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
665-674Informations de copyright
© 2021 The Author(s). Published by S. Karger AG, Basel.
Références
World J Gastrointest Endosc. 2018 Oct 16;10(10):225-238
pubmed: 30364783
Dig Liver Dis. 2020 Jan;52(1):64-71
pubmed: 31629705
Frontline Gastroenterol. 2019 Apr;10(2):93-106
pubmed: 31210174
Endoscopy. 2009 Sep;41(9):751-7
pubmed: 19693750
Gastrointest Endosc. 2015 Mar;81(3):630-6
pubmed: 25475901
Endoscopy. 2019 Jan;51(1):30-39
pubmed: 29969807
Best Pract Res Clin Gastroenterol. 2016 Jun;30(3):375-87
pubmed: 27345646
Endoscopy. 2009 Nov;41(11):923-8
pubmed: 19802773
Endoscopy. 2011 Dec;43(12):1033-8
pubmed: 22135195
PLoS One. 2020 May 8;15(5):e0232691
pubmed: 32384112
Dig Endosc. 2012 May;24 Suppl 1:129-32
pubmed: 22533768
Dig Liver Dis. 2016 Dec;48(12):1457-1462
pubmed: 27590842
United European Gastroenterol J. 2017 Feb;5(1):45-53
pubmed: 28405321
Int J Surg. 2020 Jan;73:28-41
pubmed: 31783166
World J Gastroenterol. 2018 Jun 21;24(23):2518-2536
pubmed: 29930473
Gut. 2016 Apr;65(4):607-15
pubmed: 25636697
World J Gastroenterol. 2015 Oct 28;21(40):11209-20
pubmed: 26523097
Dig Endosc. 2012 May;24 Suppl 1:136-42
pubmed: 22533770
Gastrointest Endosc. 2020 Nov;92(5):1016-1025
pubmed: 32504699
Endoscopy. 2019 Oct;51(10):980-992
pubmed: 31470448
Am J Gastroenterol. 2012 Jul;107(7):971-5
pubmed: 22764019
Dig Endosc. 2012 May;24 Suppl 1:121-3
pubmed: 22533766
Gastrointest Endosc. 2017 Feb;85(2):273-281
pubmed: 28089029
United European Gastroenterol J. 2018 May;6(4):547-557
pubmed: 29881610
United European Gastroenterol J. 2018 Nov;6(9):1410-1416
pubmed: 30386614
Endoscopy. 2015 Sep;47(9):829-54
pubmed: 26317585
Surg Endosc. 2013 Jan;27(1):154-61
pubmed: 22806508
CA Cancer J Clin. 2018 Nov;68(6):394-424
pubmed: 30207593
PLoS Biol. 2020 Jul 14;18(7):e3000410
pubmed: 32663219
Scand J Gastroenterol. 2021 Apr;56(4):492-497
pubmed: 33556257
Endoscopy. 2014 Aug;46(8):670-6
pubmed: 24977400