Endoscopic submucosal dissection: Italian national survey on current practices, training and outcomes

Maselli, Roberta; Iacopini, Federico; Azzolini, Francesco; Petruzziello, Lucio; Manno, Mauro; Luca, Luca De; Cecinato, Paolo; Fiori, Giancarla; Staiano, Teresa; Rizzotto, E. Rosa; Angeletti, Stefano; Caruso, Angelo; Coppola, F.; Andrisani, Gianluca; Viale, Edi; Missale, Guido; Panarese, Alba; Mazzocchi, Alessandro; Cesaro, Paola; Campanale, Mariachiara; Occhipinti, Pietro; Tarantino, Ottaviano; Crosta, C.; Brosolo, P.; Sferrazza, Sandro; Rondonotti, Emanuele; Amato, Arnaldo; Fuccio, Lorenzo; Costamagna, Guido; Repici, Alessandro

doi:10.1016/j.dld.2019.09.009

Cited by 20 publications

(20 citation statements)

References 21 publications

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“…However, in our series, the R0 rate for EGC (80%) was distinctly lower than that of other lesions, and the curative rate was 72.5%. These results seem to be in line with the curative rates reported in other European countries, where values ranged widely from only 7.7% to 91.7% (Table 2) [12][13][14][15][16][17]. Specifically, a learning curve could play a role in the overall results of our series over a long period, due to expected worst outcomes in the initial experience.…”

Section: Discussionsupporting

confidence: 90%

“…On the other hand, a recent long-term study found no residual disease after gastrectomy in as many as 75% of patients in whom ESD was judged to be non-curative [18]. [14] Germany 122 63.9 Petruzziello et al [12] Italy 44 65.9 Karpińska-Kaczmarczyk et al [15] Poland 41 70.7 Mocker et al [16] Germany 19 73.1 Maselli et al [12] Italy 502 81.7 Catalano et al [17] Italy 12 91.7…”

Section: Discussionmentioning

confidence: 99%

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Endoscopic Submucosal Dissection of Gastric Neoplastic Lesions: An Italian, Multicenter Study

Manta

Galloro

Pugliese

et al. 2020

JCM

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Endoscopic submucosal dissection (ESD) allows removing neoplastic lesions on gastric mucosa, including early gastric cancer (EGC) and dysplasia. Data on ESD from Western countries are still scanty. We report results of ESD procedures performed in Italy. Data of consecutive patients who underwent ESD for gastric neoplastic removal were analyzed. The en bloc resection rate and the R0 resection rates for all neoplastic lesions were calculated, as well as the curative rate (i.e., no need for surgical treatment) for EGC. The incidence of complications, the one-month mortality, and the recurrence rate at one-year follow-up were computed. A total of 296 patients with 299 gastric lesions (80 EGC) were treated. The en bloc resection was successful for 292 (97.6%) and the R0 was achieved in 266 (89%) out of all lesions. In the EGC group, the ESD was eventually curative in 72.5% (58/80) following procedure. A complication occurred in 30 (10.1%) patients. Endoscopic treatment was successful in all 3 perforations, whereas it failed in 2 out of 27 bleeding patients who were treated with radiological embolization (1 case) or surgery (1 case). No procedure-related deaths at one-month follow-up were observed. Lesion recurrence occurred in 16 (6.2%) patients (6 EGC and 10 dysplasia). In conclusion, the rate of both en bloc and R0 gastric lesions removal was very high in Italy. However, the curative rate for EGC needs to be improved. Complications were acceptably low and amenable at endoscopy.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Endoscopic Submucosal Dissection of Gastric Neoplastic Lesions: An Italian, Multicenter Study

Manta

Galloro

Pugliese

et al. 2020

JCM

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“…21,22 Because of the limitations of the training on ex vivo or live animal models before practicing on human cases. [13][14][15]23 This is useful to gain the basic ESD skills and competence in the ESD procedure. This study had some limitations.…”

Section: Discussionmentioning

confidence: 99%

Is Ex Vivo Training before In Vivo Training Effective in Learning Gastric Endoscopic Submucosal Dissection?

Pih

Lee

Ahn

et al. 2021

Korean J Helicobacter Up Gastrointest Res

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Background/Aims: The learning curve is essential in endoscopic submucosal dissection (ESD) training to improve outcomes and reduce the risk of procedure-related complications. We compared the outcomes of gastric ESD in live pigs performed by inexperienced endoscopists with or without ex vivo training.Materials and Methods: At the Olympus Medical Training and Education Center, nine endoscopists inexperienced in ESD were randomly divided into two groups (group A: ex vivo training followed by in vivo training; group B: in vivo training only), and they performed gastric ESDs.Results: A total of 18 ESDs were performed. The en bloc resection rate was 88.9% (16/18), and the complete resection rate was 94.4% (17/18). The median specimen size was 2.5 cm in group A and 2.1 cm in group B (P=0.227). There was no significant difference in the procedure time between the two groups, except for the marking time (0′58″ vs. 2′58″, P=0.027). However, group A took a shorter time in dissecting the same area than group B (109 vs. 246 sec/cm2, P=0.083). Complication rates were not significantly different between both groups.Conclusions: The procedure time during in vivo ESD training in pigs may be shortened by prior ex vivo training. However, the ex vivo model presented poor air inflation, unstable fixation, and excessive mucosal hardness for cutting. An advanced simulator or sufficient ex vivo training may be effective in training for the ESD procedure.

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“…Recently, a nationwide survey was conducted in Italy, with the participation of experts from 23 centers. In this selected population almost 60% of the operators reported less than 80 ESD operations and there was a wide variation in training protocols, practice settings and case volume/year (19) . ESD learning curve is considered to be relatively long.…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, considering that ESD is a complex procedure that even in Japan is usually practiced by a selected number of trained endoscopists, we admit that the number of responses were beyond our expectations and the number of operators involved were much higher than any other survey published so far in the Western world. Actually, other national surveys invited only endoscopists from referral centers known to perform ESD or that had published about it (17)(18)(19) , and this may be the first national survey opened to all community endoscopists that were affiliated to an Endoscopy Association. Most likely this reflects that ESD has been established globally to manage superficial neoplasms and an increasing number of specialists, particularly the youngest ones and those dedicated to therapeutic procedures are eagerly interested in embarking on ESD and to offer this kind of service to their communities.…”

Section: Discussionmentioning

confidence: 99%

Is Endoscopic Submucosal Dissection Still Limited to Few Tertiary Centers in the West? Results From a National Survey in Brazil

Arantes

Sanna

Alves

et al. 2020

Arq. Gastroenterol.

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BACKGROUND: Endoscopic submucosal dissection (ESD) enables en bloc excision of superficial neoplasms. Although ESD is widely practiced in Eastern countries like Japan, South Korea and China, its use in the West is supposed to be still limited to few tertiary centers. OBJECTIVE: This study aimed to investigate the clinical practice of ESD in Brazil by means of an electronic questionnaire elaborated by the Brazilian Society of Digestive Endoscopy (SOBED). METHODS: In October 2019, 3512 endoscopist members of SOBED were invited to respond to an electronic survey containing 40 questions divided into four topics: operator profile; clinical experience with ESD; adverse events and training. Informed consent was requested to all participants. The investigators reviewed all responses and considered valid if more than 50% of the questions were answered and additional information, when requested, was provided. RESULTS: A total of 155 (4.4%) qualified responses entered the study. ESD has been practiced in 22 of 26 Federation States and majority of respondents (32.2%) have 10 to 20 years of practice. ESD has been performed more frequently in private hospitals (101 individuals, 66.9%) and private ambulatory centers (41 individuals, 27.1%). ESD was performed mainly in the stomach (72%), followed by the rectum (57%) and 80% of the individuals reported less than 25 operations. Twenty-four (15.4 %) individuals reported perforation and 4 (2.5%) of them reported postoperative deaths. Approximately a quarter of responders denied hands-on training in models or visit to training centers. CONCLUSION: ESD appears to be practiced throughout the country, not only in tertiary or academic institutions and mainly in private practice. Most operators received limited training and still are at the beginning of their learning curve. The reported adverse events and mortality rates appear to be higher than Eastern reports.

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Endoscopic submucosal dissection: Italian national survey on current practices, training and outcomes

Cited by 20 publications

References 21 publications

Endoscopic Submucosal Dissection of Gastric Neoplastic Lesions: An Italian, Multicenter Study

Endoscopic Submucosal Dissection of Gastric Neoplastic Lesions: An Italian, Multicenter Study

Is Ex Vivo Training before In Vivo Training Effective in Learning Gastric Endoscopic Submucosal Dissection?

Is Endoscopic Submucosal Dissection Still Limited to Few Tertiary Centers in the West? Results From a National Survey in Brazil

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