Colorectal endoscopic submucosal dissection (ESD) in the West – when can satisfactory results be obtained? A single-operator learning curve analysis

Spychalski, Michał; Skulimowski, Aleksander; Dziki, Adam; Saito, Yutaka

doi:10.1080/00365521.2017.1379557

Cited by 38 publications

(31 citation statements)

References 33 publications

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“…Major challenges for implementing ESD in western countries comprise a long learning curve, high risk of complications, lack of structured training programs, few suitable starting cases in the stomach, and lack of experts 16 17 18 19 20 21 . Although there has been an increase in the number of published reports on colorectal ESD from western countries the majority of these are relatively small containing less than 100 cases with few exceptions 8 9 22 23 .…”

Section: Introductionmentioning

confidence: 99%

Endoscopic submucosal dissection of 301 large colorectal neoplasias: outcome and learning curve from a specialized center in Europe

et al. 2018

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Background and study aims Endoscopic submucosal dissection (ESD) allows en bloc resection of large colorectal lesions but ESD experience is limited outside Asia. This study evaluated implementation of ESD in the treatment of colorectal neoplasia in a Western center. Patients and methods Three hundred and one cases of colorectal ESD (173 rectal and 128 colonic lesions) were retrospectively evaluated in terms of outcome, learning curve and complications. Results Median size was 4 cm (range 1 – 12.5). En bloc resection was achieved in 241 cases amounting to an en bloc resection rate of 80 %. R0 resection was accomplished in 207 cases (69 %), RX and R1 were attained in 83 (27 %) and 11 (4 %) cases, respectively. Median time was 98 min (range 10 – 588) and median proficiency was 7.2 cm 2 /h. Complications occurred in 24 patients (8 %) divided into 12 immediate perforations, five delayed perforations, one immediate bleeding and six delayed bleedings. Six patients (2 %), all with proximal lesions, had emergency surgery. Two hundred and four patients were followed up endoscopically and median follow-up time was 13 months (range 3 – 53) revealing seven recurrences (3 %). En bloc rate improved gradually from 60 % during the first period to 98 % during the last period. ESD proficiency significantly improved between the first study period (3.6 cm 2 /h) and the last study period (10.8 cm 2 /h). Conclusions This study represents the largest material on colorectal ESD in the west and shows that colorectal ESD can be implemented in clinical routine in western countries after appropriate training and achieve a high rate of en bloc and R0 resection with a concomitant low incidence of complications. ESD of proximal colonic lesions should be attempted with caution during the learning curve because of higher risk of complications.

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Section: Introductionmentioning

confidence: 99%

Endoscopic submucosal dissection of 301 large colorectal neoplasias: outcome and learning curve from a specialized center in Europe

et al. 2018

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“…One study was not included because the R0 resection rate of colorectal ESD could not be determined [22]. Thus, after application of our inclusion and exclusion criteria, 15 European full-text studies of colorectal ESD published between 2007 and 2018 were included in this review (Table 1) [15,[23][24][25][26][27][28][29][30][31][32][33][34][35][36]. All these included studies were case series.…”

Section: Literature Searchmentioning

confidence: 99%

“…Due to the relatively difficult manoeuvrability of the colon and its thin wall, colorectal ESD is associated with increased procedure time and risk of perforation, which has contributed to the slow dissemination of ESD in western countries [10]. Major obstacles for implementing ESD in Europe comprise long learning curve, high risk of complications, lack of structured training programs, few suitable starting cases in the stomach, and lack of experts [11][12][13][14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

European experience of colorectal endoscopic submucosal dissection: a systematic review of clinical efficacy and safety

2019

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Background: Endoscopic submucosal dissection (ESD) is an advanced method allowing en bloc resection of large and complex lesions in colon and rectum. Herein, the European experience of colorectal ESD was systematically reviewed in the medical literature to determine the clinical efficacy and safety of colorectal ESD in Europe. Material and methods: A systematic search of PubMed for full-text studies including more than 20 cases of colorectal ESD emanating from European centres was performed. Data were independently extracted by two authors using predefined data fields, including efficacy and safety. Results: We included 15 studies containing a total of 1404 colorectal ESD cases (41% in the colon) performed between 2007 and 2018. Lesion size was 40 mm (range 24-59 mm) and procedure time was 102 min (range 48-176 min). En bloc resection rate was 83% (range 67-93%) and R0 resection rate was 70% (range 35-91%). Perforation rate was 7% (range 0-19%) and bleeding rate was 5% (range 0-12%). The percentage of ESD cases undergoing emergency surgery was 2% (range 0-6%). Additional elective surgery was performed in 3% of all cases due to histopathological findings showing deep submucosal invasion or more advanced cancer. The recurrence rate was 4% (range 0-12%) after a median follow-up time of 12 months (range 3-24 months). Conclusions: This review shows that ESD is effective and safe for treating large and complex colorectal lesions in Europe although there is room for improvement. Thus, it is important to develop standardized and high-quality educational programs in colorectal ESD in Europe. ARTICLE HISTORY

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“…Likewise, these techniques have shown better results than conventional ESD, especially in terms of safety, even when performed by an endoscopist with minimal experience in ESD (less than 50 real procedures). This is noteworthy, owing to the fact that in western countries as far as it is known, expertise in ESD is hardly ever achieved at the beginning of the learning period [2,13]. In a recent observational study [14], lack of counter traction guided by gravity has shown to be an independent predictive factor for difficult ESD, so it is develop of devices to help to overcome this drawback is required.…”

Section: Discussionmentioning

confidence: 99%

Electromagnetic Assisted Endoscopic Submucosal Dissection Is More Efficient Than Water-Jet Assisted and Conventional Esd in Experimental Model

Alonso

Sánchez

Belda

et al. 2018

ESGE Days 2018 Accepted Abstracts

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IntroductionEndoscopic submucosal dissection (ESD) is an advanced endoscopic procedure that has enabled en-bloc resection in lesions of any size. Moreover, ESD is a suitable technique for achieving curative resection in fibrotic and difficult polyps, with recurrence rates lower than endoscopic mucosal resection (EMR) [1]. However, in western countries, ESD is not a widely used because of the long learning curve [2], high risk of adverse events (AEs), and amount of time necessary to perform ESD (an average of 54 to 116 minutes per procedure) [3]. Avoidance of inappropriate visualization of the submucosal plane becomes crucial to perform the procedure safely because it can result in inadvertent cutting of blood vessels or the muscular layer. The reason for this drawback of the ESD procedure is that it is done entirely through a single endoscope port, unlike conventional and laparoscopic surgery. To overcome this issue, several traction techniques have been developed [4]. One of them -Magnetic anchor guided-ESD (MG-ESD) -is an attractive alternative, since it poses several advantages compared to other trac-

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Colorectal endoscopic submucosal dissection (ESD) in the West – when can satisfactory results be obtained? A single-operator learning curve analysis

Cited by 38 publications

References 33 publications

Endoscopic submucosal dissection of 301 large colorectal neoplasias: outcome and learning curve from a specialized center in Europe

Endoscopic submucosal dissection of 301 large colorectal neoplasias: outcome and learning curve from a specialized center in Europe

European experience of colorectal endoscopic submucosal dissection: a systematic review of clinical efficacy and safety

Electromagnetic Assisted Endoscopic Submucosal Dissection Is More Efficient Than Water-Jet Assisted and Conventional Esd in Experimental Model

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