Learning curve of endoscopic submucosal dissection (ESD) with prevalence-based indication in unsupervised Western settings: a retrospective multicenter analysis.
ESD
Education
Endoscopic resection
Endoscopic submucosal dissection
Gastrointestinal endoscopy
Learning curve
Journal
Surgical endoscopy
ISSN: 1432-2218
Titre abrégé: Surg Endosc
Pays: Germany
ID NLM: 8806653
Informations de publication
Date de publication:
04 2023
04 2023
Historique:
received:
06
07
2022
accepted:
14
10
2022
medline:
11
4
2023
pubmed:
8
11
2022
entrez:
7
11
2022
Statut:
ppublish
Résumé
As there is still no consensus about the adequate training strategy for ESD in Western countries, we evaluated unsupervised prevalence-based learning curves including detailed organ-specific subgroup analysis. The first 120 ESDs of four operators (n = 480) were divided into three groups (1: ESD 1-40, 2: ESD 41-80, 3: ESD 81-120). Outcome parameters were rates of technical success, en bloc and R0 resection, the resection speed, rates of conversion to EMR, curative resection, adverse events, surgery due to adverse events, and recurrence. In addition, we analyzed the achievement of quality benchmarks indicating levels of expertise. After exclusion of pretreated lesions, 438 procedures were enrolled in the final analysis. Technical success rates were > 96% with significant improvements regarding rate of en bloc resection (from 82.6 to 91.2%), resection speed (from 4.54 to 7.63 cm This trial confirms safety and feasibility of unsupervised ESD along the initial learning curve with prevalence-based indication and exclusion of colonic cases.
Sections du résumé
BACKGROUND AND AIMS
As there is still no consensus about the adequate training strategy for ESD in Western countries, we evaluated unsupervised prevalence-based learning curves including detailed organ-specific subgroup analysis.
METHODS
The first 120 ESDs of four operators (n = 480) were divided into three groups (1: ESD 1-40, 2: ESD 41-80, 3: ESD 81-120). Outcome parameters were rates of technical success, en bloc and R0 resection, the resection speed, rates of conversion to EMR, curative resection, adverse events, surgery due to adverse events, and recurrence. In addition, we analyzed the achievement of quality benchmarks indicating levels of expertise.
RESULTS
After exclusion of pretreated lesions, 438 procedures were enrolled in the final analysis. Technical success rates were > 96% with significant improvements regarding rate of en bloc resection (from 82.6 to 91.2%), resection speed (from 4.54 to 7.63 cm
CONCLUSIONS
This trial confirms safety and feasibility of unsupervised ESD along the initial learning curve with prevalence-based indication and exclusion of colonic cases.
Identifiants
pubmed: 36344898
doi: 10.1007/s00464-022-09742-5
pii: 10.1007/s00464-022-09742-5
doi:
Types de publication
Multicenter Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2574-2586Informations de copyright
© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Références
Kantsevoy SV, Adler DG, Conway JD et al (2008) Endoscopic mucosal resection and endoscopic submucosal dissection. Gastrointest Endosc 68(1):11–18. https://doi.org/10.1016/j.gie.2008.01.037
doi: 10.1016/j.gie.2008.01.037
pubmed: 18577472
Cao Y, Liao C, Tan A (2009) Meta-analysis of endoscopic submucosal dissection versus endoscopic mucosal resection for tumors of the gastrointestinal tract. Endoscopy 41(9):751–757. https://doi.org/10.1055/s-0029-1215053
doi: 10.1055/s-0029-1215053
pubmed: 19693750
Tsuji Y, Fujishiro M, Kodashima S et al (2014) Desirable training of endoscopic submucosal dissection: further spread worldwide. Ann Transl Med 2(3):27. https://doi.org/10.3978/j.issn.2305-5839.2014.02.05
doi: 10.3978/j.issn.2305-5839.2014.02.05
pubmed: 25333003
pmcid: 4200622
ASGE Standards of Practice Committee, Evans JA, Chandraskhara V, Krishnavel V et al (2015) The role of endoscopy in the management of premalignant and malignant conditions of the stomach. Gastrointest Endosc 82(1):1–8. https://doi.org/10.1016/j.gie.2015.03.1967
doi: 10.1016/j.gie.2015.03.1967
ASGE Standards of Practice Committee, Evans JA, Early DS, Chandraskhara V et al (2013) The role of endoscopy in the assessment and treatment of esophageal cancer. Gastrointest Endosc 77(3):328–334. https://doi.org/10.1016/j.gie.2012.10.001
doi: 10.1016/j.gie.2012.10.001
Kaltenbach T, Anderson JC, Burke CA et al (2020) Endoscopic removal of colorectal lesions recommendations by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology 158(4):1095–1125. https://doi.org/10.1053/j.gastro.2019.12.018
doi: 10.1053/j.gastro.2019.12.018
pubmed: 32122632
Pimentel-Nunes P, Dinis-Ribeiro M, Ponchon T et al (2015) Endoscopic submucosal dissection: European Society of Gastroenterology (ESGE) Guideline. Endoscopy 47:829–854. https://doi.org/10.1055/s-0034-1392882
doi: 10.1055/s-0034-1392882
pubmed: 26317585
Porschen R, Fischbach W, Gockel I et al (2019) S3-Leitlinie Diagnostik und Therapie der Plattenepithelkarzinome und Adenokarzinome des Ösophagus. Z Gastroenterol 57:336–418. https://doi.org/10.1055/a-0833-5712
doi: 10.1055/a-0833-5712
pubmed: 30861559
Moehler M, Al-Batran S-E, Andus T et al (2019) S3-Leitlinie Magenkarzinom—Diagnostik und Therapie der Adenokarzinome des Magens und des ösophagogastralen Übergangs. Z Gastroenterol 57(12):1517–1632. https://doi.org/10.1055/a-1018-2516
doi: 10.1055/a-1018-2516
pubmed: 31826284
Schmiegel W, Buchberger B, Follmann M et al (2017) S3-Leitlinie Kolorektales Karzinom. Z Gastroenterol 55(12):1344–1498. https://doi.org/10.1055/s-0043-121106
doi: 10.1055/s-0043-121106
pubmed: 29212104
Pimentel-Nunes P, Pioche M, Albéniz E et al (2019) Curriculum for endoscopic submucosal dissection training in Europe: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy 51:980–992. https://doi.org/10.1055/a-0996-0912
doi: 10.1055/a-0996-0912
pubmed: 31470448
Aihara H, Dacha S, Anand GS et al (2021) Core curriculum for endoscopic submucosal dissection (ESD). Gastrointest Endcosc 93(6):1215–1221. https://doi.org/10.1016/j.gie.2021.01.026
doi: 10.1016/j.gie.2021.01.026
Oyama T, Yahagi N, Ponchon T et al (2015) How to establish endoscopic submucosal dissection in Western countries. World J Gastroenterol 21(40):11209–11220. https://doi.org/10.3748/wjg.v21.i40.11209
doi: 10.3748/wjg.v21.i40.11209
pubmed: 26523097
pmcid: 4616199
Uraoka T, Parra-Blanco A, Yahagi N (2013) Colorectal endoscopic submucosal dissection: is it suitable in Western countries? J Gastroenterol Hepatol 28(3):406–414. https://doi.org/10.1111/jgh.12099
doi: 10.1111/jgh.12099
pubmed: 23278302
Hotta K, Oyama T, Shinohara T, Miyata Y, Takahashi A, Kitamura Y, Tomori A (2010) Learning curve for endoscopic submucosal dissection of large colorectal tumors. Dig Endosc 22:302–306. https://doi.org/10.1111/j.1443-1661.2010.01005.x
doi: 10.1111/j.1443-1661.2010.01005.x
pubmed: 21175483
Niimi K, Fujishiro M, Goto O, Kodashima S, Koike K (2012) Safety and efficacy of colorectal endoscopic submucosal dissection by the trainee endoscopists. Dig Endosc 24(Suppl 1):154–158. https://doi.org/10.1111/j.1443-1661.2012.01251.x
doi: 10.1111/j.1443-1661.2012.01251.x
pubmed: 22533773
Shiga H, Kuroha M, Endo K et al (2015) Colorectal endoscopic submucosal dissection (ESD) performed by experienced endoscopists with limited experience in gastric ESD. Int J Colorectal Dis 30(12):1645–1652. https://doi.org/10.1007/s00384-015-2334-3
doi: 10.1007/s00384-015-2334-3
pubmed: 26243470
Shiga H, Ohba R, Matsuhashi T et al (2017) Feasability of colorectal endoscopic submucosal dissection (ESD) carried out by endoscopists with no or little experience in gastric ESD. Dig Endosc 29(Suppl):58–65. https://doi.org/10.1111/den.12814
doi: 10.1111/den.12814
pubmed: 28425662
Yang DH, Jeong GH, Song Y et al (2015) The feasibility of performing colorectal endoscopic submucosal dissection without previous experience in performing gastric endoscopic submucosal dissection. Dig Dis Sci 60(11):3431–3441. https://doi.org/10.1007/s10620-015-3755-0
doi: 10.1007/s10620-015-3755-0
pubmed: 26088371
Aslan F, Alper E, Cekic C et al (2015) Endoscopic submucosal dissection in gastric lesions: the 100 cases experience from a tertiary referral center in West. Scand J Gastroenterol 50:368–375. https://doi.org/10.3109/00365521.2014.999253
doi: 10.3109/00365521.2014.999253
pubmed: 25582554
Catalano F, Mengardo V, Trecca A et al (2019) The impact of experience on short- and long-term outcomes on gastric ESD: a Western series. Updates Surg 71(2):359–365. https://doi.org/10.1007/s13304-019-00628-1
doi: 10.1007/s13304-019-00628-1
pubmed: 30710244
Iacopini F, Bella A, Costamagna G, Gotoda T, Saito Y, Elisei W, Grossi C, Rigato P, Scozzarro A (2012) Stepwise training in rectal and colonic endoscopic submucosal dissection with differentiated learning curves. Gastrointest Endosc 76:1188–1196. https://doi.org/10.1016/j.gie.2012.08.024
doi: 10.1016/j.gie.2012.08.024
pubmed: 23062760
Probst A, Golger D, Anthuber M, Märkl B, Messmann H (2012) Endoscopic submucosal dissection in large sessile lesions of the rectosigmoid: learning curve in a European center. Endoscopy 44:660–667. https://doi.org/10.1055/s-0032-1309403
doi: 10.1055/s-0032-1309403
pubmed: 22528673
Agapov M, Dvoinikova E (2014) Factors predicting clinical outcomes of endoscopic submucosal dissection in the rectum and sigmoid colon during the learning curve. Endosc Int Open 02:E235–E240. https://doi.org/10.1055/s-0034-1377613
doi: 10.1055/s-0034-1377613
Sauer M, Hildenbrand R, Oyama T et al (2016) Endoscopic submucosal dissection for flat or sessile colorectal neoplasia > 20 mm: a European single-center series of 182 cases. Endosc Int Open 4(8):E895–E900. https://doi.org/10.1055/s-0042-111204
doi: 10.1055/s-0042-111204
pubmed: 27540580
pmcid: 4988858
Rönnow CF, Uedo N, Toth E et al (2018) Endoscopic submucosal dissection of 301 large colorectal neoplasias: outcome and learning curve from a specialized center in Europe. Endosc Int Open 06:E1340–E1348. https://doi.org/10.1055/a-0733-3668
doi: 10.1055/a-0733-3668
Gupta N, Rodriguez-Ruiz G, Siddiqui UD et al (2022) Endoscopic submucosal dissection for colorectal lesions: outcomes from a United States experience. Surg Endosc. https://doi.org/10.1007/s00464-020-08262-4
doi: 10.1007/s00464-020-08262-4
pubmed: 36315284
Berr F, Wagner A, Kiesslich T, Friesenbichler P, Neureiter D (2014) Untutored learning curve to establish endoscopic submucosal dissection on competence level. Digestion 89:184–193. https://doi.org/10.1159/000357805
doi: 10.1159/000357805
pubmed: 24714421
Höbel S, Baumbach R, Dautel P et al (2014) Single center experience of endoscopic submucosal dissection (esd) in premalignant and malignant gastrointestinal neoplasia. Z Gastroenterol 52:193–199. https://doi.org/10.1007/s00464-014-3847-5 (Article in German)
doi: 10.1007/s00464-014-3847-5
pubmed: 24526404
Zhang X, My EK, Nithyanand S et al (2020) Learning curve for endoscopic submucosal dissection with an untutored, prevalence-based approach in the United States. Clin Gastroenterol Hepatol 18(3):580–588. https://doi.org/10.1016/j.cgh.2019.06.008
doi: 10.1016/j.cgh.2019.06.008
pubmed: 31220645
Fleischmann C, Probst A, Ebigbo A et al (2021) Endoscopic submucosal dissection in Europe: results of 1000 neoplastic lesions from the German Endoscopic Submucosal Dissection Registry. Gastroenterology 161:1168–1178. https://doi.org/10.1053/j.gastro.2021.06.049
doi: 10.1053/j.gastro.2021.06.049
pubmed: 34182002
Höbel S, Dautel P, Baumbach R et al (2015) Single center experience of endoscopic submucosal dissection (ESD) in early Barrett’s adenocarcinoma. Surg Endosc 29(6):1591–1597. https://doi.org/10.1007/s00464-014-3847-5
doi: 10.1007/s00464-014-3847-5
pubmed: 25294533
Suchy C, Berger M, Steinbrück I et al (2021) Long-term follow-up after colorectal endoscopic submucosal dissection in 182 cases. Endosc Int Open 09(02):E258–E262. https://doi.org/10.1055/a-1321-1271
doi: 10.1055/a-1321-1271
Mocker L, Hildenbrand R, Oyama T et al (2019) Implementation of endoscopic submucosal dissection for early upper gastrointestinal tract cancer after primary experience in colorectal endoscopic submucosal dissection. Endosc Int Open 07(04):E446–E451. https://doi.org/10.1055/a-0854-3610
doi: 10.1055/a-0854-3610
Spychalski M, Skulimowski A, Dziki A et al (2017) Colorectal endoscopic submucosal dissection (ESD) in the West—when can satisfactory results can be obtained? A single-operator learning curve analysis. Scand J Gastroenterol 52(12):1442–1452. https://doi.org/10.1080/00365521.2017.1379557
doi: 10.1080/00365521.2017.1379557
pubmed: 28942690
Ramos-Zabala F, Parra-Blanco A, Beg S et al (2020) Feasibility and learning curve of unsupervised colorectal endoscopic submucosal hydrodissection at a Western Center. Eur J Gastroenterol Hepatol 32:804–812. https://doi.org/10.1097/MEG.0000000000001703
doi: 10.1097/MEG.0000000000001703
pubmed: 32175984
Boda K, Oka S, Tanaka S et al (2020) Real-world learning curve analysis of colorectal endoscopic submucosal dissection: a large multicenter study. Surg Endosc 34(8):3344–3351. https://doi.org/10.1007/s00464-019-07104-2
doi: 10.1007/s00464-019-07104-2
pubmed: 31482350
Zorron Cheng Tao PuL, Yamamura T, Nakamura M et al (2020) Learning curve for mastery of colorectal endoscopic submucosal dissection: perspectives from a large Japanese cohort. JGH Open 4(4):611–616. https://doi.org/10.1002/jgh3.12298
doi: 10.1002/jgh3.12298
Ebigbo A, Probst A, Römmele C et al (2018) Step-up training for colorectal and gastric ESD and the challenge of ESD training in the proximal colon: results from a German center. Endosc Int Open 6(5):E524–E530. https://doi.org/10.1055/a-0584-6457
doi: 10.1055/a-0584-6457
pubmed: 29713678
pmcid: 5909775
Küttner-Magalhaes R, DInis-Ribeiro M, Marcos-Pinto R et al (2022) Endoscopic submucosal dissection (ESD) skills transfer to clinical practice after hands-on workshops: an international survey. Dig Dis 40(5):665–674. https://doi.org/10.1159/000521274
doi: 10.1159/000521274
pubmed: 34856553