Learning Curve for Endoscopic Submucosal Dissection With an Untutored, Prevalence-Based Approach in the United States

Zhang, Xiaocen; Ly, Erin K.; Nithyanand, Sagarika; Modayil, Rani J.; Khodorskiy, Dmitriy O.; Neppala, Sivaram; Bhumi, Sriya; DeMaria, Matthew; Widmer, Jessica L.; Friedel, David; Grendell, James H.; Stavropoulos, Stavros N.

doi:10.1016/j.cgh.2019.06.008

Cited by 55 publications

(44 citation statements)

References 33 publications

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“…Zhang et al . described achieving an en bloc resection rate of over 90% and an R0 resection rate of over 80% at nearly 250 ESD cases, but included both UGI and LGI lesions (55% right colonic lesions).…”

Section: Resultsmentioning

confidence: 99%

“…Thirteen studies described trainees who started colorectal ESD with previous upper gastrointestinal (UGI) ESD experience . Twelve studies described trainees with previous experience on animal models . Inada et al .…”

Section: Resultsmentioning

confidence: 99%

“…The benchmark proficiency of 6.7 min/cm 2 was achieved at 76 or 120 colorectal cases . Zhang et al reported the achievement of benchmark proficiency after 250 cases but included both UGI and LGI ESD and did not report procedural speed on colorectal cases alone.…”

Section: Resultsmentioning

confidence: 99%

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Systematic literature review of learning curves for colorectal polyp resection techniques in lower gastrointestinal endoscopy

et al. 2020

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Aim The performance of therapeutic procedures in lower gastrointestinal endoscopy (LGI) can be challenging and carries an increased risk of adverse events. There is increasing demand for the training of endoscopists in these procedures, but limited guidelines exist concerning procedural competency. The aim of this study was to assess the learning curves for LGI polypectomy, colorectal endoscopic mucosal resection (EMR) and colorectal endoscopic submucosal dissection (ESD). Method A systematic review of electronic databases between 1946 and September 2019 was performed. Citations were included if they reported learning curve data. Outcome measures that defined the success of procedural competency were also recorded. Results A total of 34 out of 598 studies met the inclusion criteria of which 28 were related to ESD, three to polypectomy and three to EMR. Outcome measures for polypectomy competency (en bloc resection, delayed bleeding and independent polypectomy rate) were achieved after completion of between 250 and 400 polypectomies and after 300 colonoscopies. EMR outcome measures, including complete resection and recurrence, were achieved variably between 50 and 300 procedures. Outcome measures for ESD included efficiency (resection rates and procedural speed) and safety (adverse events). En bloc resection rates of over 80% and R0 resection rates of over 70% were achieved at 20-40 cases and procedural speed increased after 30 ESD cases. Competency in safety metrics was variably achieved at 20-200 cases. Conclusion There is a paucity of data on learning curves in LGI polypectomy, EMR and ESD. Despite limited evidence, we have identified relevant outcome measures and threshold numbers for the most common LGI polyp resection techniques for potential inclusion in training programmes/credentialing guidelines.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Systematic literature review of learning curves for colorectal polyp resection techniques in lower gastrointestinal endoscopy

et al. 2020

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“…In addition, a Japanese multicenter retrospective study reported positive outcomes in low-volume centers, although the en bloc resection rates were reported to be lower than the rates in high-volume centers [20]. Although the reports on the use of CR-ESD and its favorable outcomes are gradually increasing in non-Asian countries, ESD still does not have a satisfactory performance level [21][22][23][24][25][26][27][28][29][30]. Favorable results such as high complete, en bloc, and curative resection rates during the introductory period, indicate that using SB Knife Jr might benefit the adoption of CR-ESD in developing facilities such as Asian general hospitals and non-Asian countries.…”

Section: Discussionmentioning

confidence: 99%

Learning curve for endoscopic submucosal dissection of early colorectal neoplasms with a monopolar scissor-type knife: use of the cumulative sum method

Miyakawa

Kuwai

Sakuma

et al. 2020

Scandinavian Journal of Gastroenterology

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Objective: Although scissor-type knives such as the Stag-Beetle (SB) Knife Jr are expected to result in a safe and easy colorectal endoscopic submucosal dissection (CR-ESD), information regarding the learning curve is lacking. Therefore, this study evaluated the learning curve with using SB Knife Jr. Materials and methods: We retrospectively reviewed 507 CR-ESD procedures performed in 464 patients using SB Knife Jr. The primary endpoint was a learning curve to achieve a satisfactory complete resection rate. The secondary endpoints were learning curves to achieve a satisfactory en bloc resection rate, curative resection rate, and resection speed. Results: The complete, en bloc, and curative resection rates were 91.9%, 95.9%, and 84.0%, respectively. Moving average analysis showed that 39 cases were required for a complete resection rate of >80%, 41 for an en bloc resection rate of >90%, and 50 for a curative resection rate of >75%. We divided the procedure into three phases using the cumulative sum method: I, II, and III (cases 1-36, 37-119, and 120-507, respectively). Although we found no significant between-phase differences, the complete resection rate showed an increasing trend in Phase III (83.3 vs. 89.2 vs. 93.3%; p ¼ .099). The en bloc resection rate (91.7 vs. 91.6 vs. 97.2%; p ¼ .047) and resection speed (20.5 vs. 7.2 vs. 6.8 min/ cm 2 ; p < .001) were greater in Phase III. Despite the larger specimen size (27.3 vs. 38.2 vs. 40.4 mm; p < .001) and more severe fibrosis (p < .001) in Phase III, the procedure time was shorter (73.8 vs. 57.8 vs. 54.2 min; p ¼ .041). The curative resection rate was not significantly different between phases. Conclusions: SB Knife Jr enables safe and easy CR-ESD during the introductory period compared to the conventional tip-type knife and has an acceptable learning curve. Therefore, using this knife will encourage the widespread adoption of CR-ESD in Asian general hospitals and non-Asian countries.

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“…[22][23][24][25] This is pivotal as untutored, prevalence-based ESD training would result in a significantly higher number of cases (approximately 250 cases) before reaching technical proficiency. 26 At present, there exists a gap in baseline didactic training and understanding between the USA and Japan. Current general gastroenterology fellowship as well as advanced endoscopy fellowship training in the USA does not emphasize understanding and use of the Paris classification, NBI International Colorectal Endoscopy (NICE) classification, 27 Japan NBI Expert Team (JNET) classification, 28 electrosurgical generator setting, and interpretation of resection outcomes such as en-bloc and R 0 resectionall skills essential for ESD training.…”

Section: Traditional Training Modelmentioning

confidence: 99%

Current state of education and training for endoscopic submucosal dissection: Translating strategy and success to the USA

McCarty

Aihara

2020

Digestive Endoscopy

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Endoscopic submucosal dissection (ESD) is a rigorous and technically sophisticated method for removal of lesions within the gastrointestinal tract. Despite having advantages of en‐bloc resection of lesions, regardless of size, and widespread use in Japan and Asia, ESD has not become widely adopted in the USA for a variety of reasons. Based upon Japanese education and the master‐apprentice model, modification to the education system and additional techniques designed to facilitate broader adoption are required for trainees in the USA. This article will review the current state of education and training for ESD in the USA.

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Learning Curve for Endoscopic Submucosal Dissection With an Untutored, Prevalence-Based Approach in the United States

Cited by 55 publications

References 33 publications

Systematic literature review of learning curves for colorectal polyp resection techniques in lower gastrointestinal endoscopy

Systematic literature review of learning curves for colorectal polyp resection techniques in lower gastrointestinal endoscopy

Learning curve for endoscopic submucosal dissection of early colorectal neoplasms with a monopolar scissor-type knife: use of the cumulative sum method

Current state of education and training for endoscopic submucosal dissection: Translating strategy and success to the USA

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