Endoscopic mucosal resection: learning curve for large nonpolypoid colorectal neoplasia

Bhurwal, Abhishek; Bartel, Michael J.; Heckman, Michael G.; Diehl, Nancy N.; Raimondo, Massimo; Wallace, Michael B.; Woodward, Timothy A.

doi:10.1016/j.gie.2016.04.020

Cited by 47 publications

(33 citation statements)

References 26 publications

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“…Irrespective of these differences, it is clear that further data from endoscopists across different practice settings are necessary to understand the learning curve of colorectal EMR. ▶ EMR outcomes in our study were consistent with those described in the Western literature (Supplemental Table 4) [8,9,15,[19][20][21][22][23]. These results suggest that gastroenterologists without additional formal advanced endoscopy training can acquire the necessary skill set for EMR through dedicated, comprehensive training.…”

Section: Discussionsupporting

confidence: 88%

“…Continuous variables were summarized using the mean, median, standard deviation, and range; categorical variables were presented using the number and percentage. The three primary outcomes were assessed using a combination of descriptive summaries and graphical evaluation [15]. Specifically, EMR cases were divided chronologically into groups of 20 sequential EMRs, determined a priori based on a prior study [15], and rates of the primary outcomes were calculated; these data were also represented graphically.…”

Section: Resultsmentioning

confidence: 99%

“…The three primary outcomes were assessed using a combination of descriptive summaries and graphical evaluation [15]. Specifically, EMR cases were divided chronologically into groups of 20 sequential EMRs, determined a priori based on a prior study [15], and rates of the primary outcomes were calculated; these data were also represented graphically. In addition, established risk factors associated with neoplasia recurrence after EMR [18] such as polyp size, prior manipulation (prior biopsy, snare and/ or injection), and en-bloc resection were analyzed according to sequential EMR cases.…”

Section: Resultsmentioning

confidence: 99%

“…Outcomes in this study can be compared to the single published study [15] of EMR learning curves for large colorectal polyps, which reported outcomes of three academic advanced endoscopists without appreciable EMR experience prior to the examined period. The study identified a threshold of 100 EMRs for large colorectal polyps to achieve rates of residual neoplasia below 20 % and complete resection above 75 %.…”

Section: Discussionmentioning

confidence: 99%

“…There are, at best, limited suggestions and guidance on a core EMR curriculum [14]. Furthermore, only a single prior study [15] examined the learning curve of colon EMR among three established, academic advanced endoscopists. Few studies to date have reported EMR outcomes in the West and nearly all data on rate of en-bloc resection, residual neoplasia, and adverse events (AEs) have come from experienced endoscopists.…”

Section: Introductionmentioning

confidence: 99%

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Impact of observational training on endoscopic mucosal resection outcomes and competency for large colorectal polyps: single endoscopist experience

et al. 2020

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Background and study aims Endoscopic mucosal resection (EMR) is standard treatment for large colorectal polyps. However, it is a specialized technique with limited data on the effectiveness of training methods to acquire this skill. The aim of this study was to evaluate the impact of observational training on EMR outcomes and competency in an early-stage endoscopist. Patients and methods A single endoscopist completed comprehensive EMR training, which included knowledge acquisition and direct observation of EMR cases, and proctored supervision, during the third year of gastroenterology fellowship. After training, EMR was independently attempted on 142 consecutive, large (i. e., ≥ 20 mm), non-pedunculated colorectal polyps between July 2014 and December 2017 (mean age 61.7 years; mean polyp size 30.4 mm; en-bloc resection 55 %). Surveillance colonoscopy for evaluation of residual neoplasia was available for 86 % of the cases. Three primary outcomes were evaluated: endoscopic assessment of complete resection, rate of adverse events (AEs), and rate of residual neoplasia on surveillance colonoscopy. Results Complete endoscopic resection was achieved in 93 % of cases, the rates of AEs and residual neoplasia were 7.8 % and 7.3 %, respectively. The rate of complete resection remained stable (at 85 % or greater) with increasing experience while rates of AEs and residual neoplasia peaked and decreased after 60 cases. Conclusions An early-stage endoscopist can acquire the skills to perform effective EMR after completing observational training. At least 60 independent EMRs for large colorectal polyps were required to achieve a plateau for clinically meaningful outcomes.

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