Learning Curve for Endoscopic Submucosal Dissection of Large Colorectal Tumors

Hotta, Kinichi; Oyama, Tsuneo; Shinohara, Tomoaki; Miyata, Yoshinori; Takahashi, Akiko; Kitamura, Yoko; Tomori, Akihisa

doi:10.1111/j.1443-1661.2010.01005.x

Cited by 169 publications

(137 citation statements)

References 34 publications

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“…Therefore, the clinical outcomes such as proficiency and procedure time in our study might be greater than those of previous reports. 19,22 As colorectal epithelial tumors in our study were relatively smaller than those of previous reports, they would also affect the clinical outcomes. 19 The third limitation is that the study was designed for just one endoscopist in a single center.…”

Section: Discussioncontrasting

confidence: 42%

“…19,22 As colorectal epithelial tumors in our study were relatively smaller than those of previous reports, they would also affect the clinical outcomes. 19 The third limitation is that the study was designed for just one endoscopist in a single center. However, it is not easy to conduct a multicenter study with multiple endoscopists because there might be heterogeneity in basic skill and ability to acquire the procedure among endoscopists from different institutes.…”

Section: Discussioncontrasting

confidence: 42%

“…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%

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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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Section: Discussioncontrasting

confidence: 42%

Section: Discussioncontrasting

confidence: 42%

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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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“…На начальном этапе внедре-ния в практику указанный метод сопровождался тех-ническими трудностями и большим количеством осложнений, что постепенно удалось во многом пре-одолеть с накоплением опыта и отработкой методики данного вмешательства [16,17]. Как показал ретро-спективный анализ [18], частота осложнений ESD уменьшается в среднем после 40 выполненных опера-ций. Подслизистая диссекция в толстой кишке харак-теризуется повышенным риском перфорации стенки органа, так как эта стенка здесь тоньше, а стабилиза-ция эндоскопа технически более сложна, чем в желуд-ке или пищеводе [17].…”

Section: Introductionunclassified

Endoscopic Technologies in Early Rectal Cancer Treatment

Самсонов¹,

Карачун²,

Tkachenko³

2015

Onkol. koloproktol.

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“…Dinis-Ribeiro et al [52] suggested that only after performing 20-40 ESDs in the distal stomach, should lesions located in proximal sites in the stomach, esophagus, and colon be tried. Hotta et al [53] reported on the learning curve for colonic ESD, and they concluded that performance of approximately 40 procedures was sufficient to acquire the skill to avoid causing perforations during the ESD procedure, and approximately 80 procedures must be carried out to acquire adequate skill to successfully remove large colorectal tumors. Sakamoto et al [54] reported that trainees can perform colorectal ESD safely and independently after preparatory training and experience with more than 30 cases.…”

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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Learning Curve for Endoscopic Submucosal Dissection of Large Colorectal Tumors

Abstract: Based on our analysis of the learning curve, approximately 80 procedures must be carried out to acquire skill with ESD for large colorectal tumors. However, approximately 40 procedures were sufficient to acquire skill in avoiding perforations during the ESD procedure.

Cited by 169 publications

References 34 publications

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

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

Endoscopic Technologies in Early Rectal Cancer Treatment

Training in endoscopic submucosal dissection

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