Effective Training System in Colorectal Endoscopic Submucosal Dissection

Ohata, Ken; Ito, Takafumi; Chiba, Hideyuki; Tsuji, Yosuke; Matsuhashi, Nobuyuki

doi:10.1111/j.1443-1661.2012.01272.x

Cited by 63 publications

(48 citation statements)

References 23 publications

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“…Hotta et al [21] suggested that about 40 treatments must be performed to achieve a perforation rate of less than 5%, whereas about 80 treatments must be performed to achieve proficiency, defined as reduced procedure time and good resection results. However, Sakamoto et al [22] and Ohata et al [23] showed that 30 ESD treatments performed independently in the colon were sufficient to obtain an acceptable R0 resection rate, procedure duration, and complication rate. This learning curve was confirmed by studies showing that during the first 25 treatments, the perforation rates were 12-28% [24][25][26][27].…”

Section: Discussionmentioning

confidence: 98%

Treatment of large colorectal neoplasms by endoscopic submucosal dissection

Białek

Pertkiewicz²,

Karpińska-Kaczmarczyk³

et al. 2014

European Journal of Gastroenterology &Amp; Hepatology

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Section: Discussionmentioning

confidence: 98%

Treatment of large colorectal neoplasms by endoscopic submucosal dissection

Białek

Pertkiewicz²,

Karpińska-Kaczmarczyk³

et al. 2014

European Journal of Gastroenterology &Amp; Hepatology

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“…If the cases were assisted by experts during the trainee's performance of the procedure, it might affect clinical outcomes favorably. 18 Second, different endoscopic equipment for ESD was used in each study. A former Japanese study used a pediatric-type colonoscope (PCF-Q260JI; Olympus Optical Co.) with a built-in water jet system and a carbon dioxide insufflation system while we used a conventional colonoscope with an air insufflation system.…”

Section: Discussionmentioning

confidence: 99%

“…R0 resection was defined as an en-bloc resection without tumor involvement to the lateral and vertical margins of the resected specimen in a pathologic diagnosis. 18 We used the proficiency that was calculated as the procedure time per specimen area (min/cm 2 ). 19 Complications related to ESD procedures such as perforation and…”

Section: Assessment Of Learning Curvementioning

confidence: 99%

Chronological Outcomes and Learning Curve of Endoscopic Submucosal Dissection for Colorectal Tumors

Lee

Kim

Park

et al. 2014

Korean J Gastroenterol

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Background/Aims: Endoscopic submucosal dissection (ESD) is an effective procedure for en-bloc curative resection of the colorectal tumor. As it requires high technical skills and experience in therapeutic endoscopy, it is important to understand learning curve of ESD technique. The aim of this study was to retrospectively describe the clinical results of ESD and to evaluate learning curve for the ESD of colorectal tumors. Methods: A total of 90 patients with 90 colorectal neoplasms, who had undergone ESD at a tertiary referral hospital from July 2009 to December 2012, were enrolled. The ESD was performed by a single endoscopist. All ESD cases were divided into three periods: first, cases 1-30; second, cases 31-60; and third, cases 61-90. Results: The en-bloc resection rates in third period (100%) was significantly higher than that of the first (93.3%) and second period (80%) (p=0.025). The perforation rate in third period (0%) also significantly decreased compared with that of the first (13.3%) and second period (20%) (p=0.032). To calibrate the difference of tumor size among periods, proficiency was calculated, as the procedure time per specimen area (min/cm 2 ). The proficiency in third period (4.3) was significantly shorter than that of the first (16.8) and second period (10.2) (p=0.004). Conclusions: The learning curve of colorectal ESD in our study shows that at least 60 cases of ESD have to be conducted to acquire sufficient skill of degree without perforation. (Korean J Gastroenterol 2014;64:198-205)

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“…Despite greater risks of postoperative complications, particularly, more and more endoscopists are making an effort to study this new technique in terms of its capability of larger neoplasms resection, higher en-bloc resection rate and lower local recurrence rate of neoplasms in comparison with other endoscopic treatments. Ohata et al [56] proposed a 7-step training system for learning colorectal ESD, which is very similar to the training algorithms used for gastric ESD, but with the emphasis on technical differences imposed by performing the procedure in a narrower space with thinner wall. One of the mandatory enrolment criteria was performance of at least 30 gastric ESDs.…”

Section: Learning Curve For Gastric Esdmentioning

confidence: 99%

“…The study found that, regardless of the gastric ESD experience, the mean procedure time of each trainee became less than 80 min after performing more than 30 cases. Trainees with experience in many (i.e., 200) gastric ESDs could perform colorectal ESD skillfully from the initial period of training onward [56] .…”

Section: Learning Curve For Gastric Esdmentioning

confidence: 99%

Training in endoscopic submucosal dissection

Coman

Gotoda²,

Draganov³

2013

WJGE

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Endoscopic submucosal dissection (ESD) represents an important advancement in the therapy of early neoplastic gastrointestinal lesions by providing higher en-bloc curative resection rate with lower recurrence compared to endoscopic mucosal resection (EMR) and by sparing the involved organ and protecting patient' s quality of life. Despite these advantages ESD is associated with long procedure times and a higher rate of complications, making ESD a challenging procedure which requires advanced endoscopic skills. Thus, there has been a recognized need for structured training system for ESD to enhance trainee experience and, to reduce the risks of complications and inadequate treatment. ESD has a very flat learning curve. However, we do not have uniformly accepted benchmarks for competency. Nevertheless, it appears that, in Japan, more than 30 supervised gastric ESD procedures are required to achieve technical proficiency and minimize complications. A number of training algorithms have been proposed in Japan with the aim to standardize ESD training. These algorithms cannot be directly applied in the West due to substantial differences including the availability of highly qualified mentors, the type of pathology seen, choice of devices, and trainee's background. We propose a training algorithm for Western physicians which integrates both hands-on training courses, animal model work as well as visits to expert centers. No specific preceptor training programs have been yet developed but there is a consensus that these programs are important for permeation of ESD worldwide. Key words: Endoscopic submucosal dissection; Training; Learning curve; Early gastrointestinal cancer; Endoscopic mucosal resection Core tip: Endoscopic submucosal dissection (ESD) is a complex procedure associated with high complication rate. In Japan, training in ESD follows the traditional mentor/apprentice approach but significant variability in training approaches exists. We review the learning curves for ESD and describe the training algorithm proposed in Japan aiming to standardize training, and its applicability in the West. We highlight the challenges for ESD dissemination in the West, describing both the consensus and the diverging opinions between Asian and Western training models. Finally, we emphasize the need for structured training system to enhance trainee experience and, most importantly, to reduce the risks of complications and inadequate treatment.Coman RM, Gotoda T, Draganov PV. Training in endoscopic submucosal dissection. World J Gastrointest Endosc 2013; 5(8): 369-378 Available from:

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Effective Training System in Colorectal Endoscopic Submucosal Dissection

Cited by 63 publications

References 23 publications

Treatment of large colorectal neoplasms by endoscopic submucosal dissection

Treatment of large colorectal neoplasms by endoscopic submucosal dissection

Chronological Outcomes and Learning Curve of Endoscopic Submucosal Dissection for Colorectal Tumors

Training in endoscopic submucosal dissection

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