The Feasibility of Performing Colorectal Endoscopic Submucosal Dissection Without Previous Experience in Performing Gastric Endoscopic Submucosal Dissection

Yang, Dan; Jeong, Gwi Hong; Song, Yong Jin; Park, Sang Hyoung; Park, Soo-Kyung; Kim, Jong Wook; Jung, Kee Wook; Kim, Kyung‐Jo; Ye, Byong Duk; Myung, Seung‐Jae; Yang, Suk-Kyun; Kim, Jin-Ho; Park, Young Soo

doi:10.1007/s10620-015-3755-0

Cited by 46 publications

(31 citation statements)

References 44 publications

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“…Yang et al . also reported the feasibility of colorectal ESD carried out by an endoscopist without experience in gastric ESD . However, different from our study, more than 100 colorectal ESD were needed to become proficient.…”

Section: Discussioncontrasting

confidence: 65%

“…Yang et al also reported the feasibility of colorectal ESD carried out by an endoscopist without experience in gastric ESD. 20 However, different from our study, more than 100 colorectal ESD were needed to become proficient. As Ohata et al have emphasized, 21 supervision by experts might contribute to the present better results.…”

Section: E Ndoscopic Mucosal Resection Is the Standard Endoscopic Trecontrasting

confidence: 74%

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Feasibility of colorectal endoscopic submucosal dissection (ESD) carried out by endoscopists with no or little experience in gastric ESD

Shiga

Ohba

Matsuhashi

et al. 2017

Digestive Endoscopy

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Background and Aim: Colorectal endoscopic submucosal dissection (ESD) is recommended to be carried out only by endoscopists with sufficient experience in gastric ESD. However, early gastric carcinoma is less common in Western countries than in Japan, and endoscopic maneuverability differs between the stomach and colorectum. We assessed the feasibility of colorectal ESD carried out by endoscopists with no or little experience in gastric ESD. Methods:We analyzed en bloc resection, R0 resection and perforation rates in 180 consecutive colorectal ESD carried out by three endoscopists who had no or <5 cases of experience in gastric ESD. We also identified factors associated with R0 resection failure.Results: Overall en bloc and R0 resection rates were 93.3% (168/180) and 82.2% (148/180), respectively. All 11 cases with perforation were treated endoscopically. Dividing 180 cases into three learning phases (early, middle, or late phases), the en bloc and R0 resection rates increased from 88.3% and 75.0% in the early phase to 98.3% and 88.3% in the late phase, respectively. Perforation rate also improved from 10.0% to 3.3%. Factors associated with R0 resection failure were location at junctions (odds ratio: 6.8, 95% CI: 1.9-27.5), preoperative factors reflecting fibrosis (5.8, 1.9-19.0), and late phase (0.2, 0.1-0.7). Conclusion: Endoscopists without experience in gastric ESDcarried out colorectal ESD safely. In the early and middle phases (≤40 cases), they should treat mainly rectal lesions but may also resect lesions in the colon avoiding flexures. Lesions located at junctions and those with preoperative factors reflecting fibrosis should be resected after completing 40 procedures.

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Section: Discussioncontrasting

confidence: 65%

Section: E Ndoscopic Mucosal Resection Is the Standard Endoscopic Trecontrasting

confidence: 74%

Feasibility of colorectal endoscopic submucosal dissection (ESD) carried out by endoscopists with no or little experience in gastric ESD

Shiga

Ohba

Matsuhashi

et al. 2017

Digestive Endoscopy

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“…B. wurden in einer Arbeit zur EMR freie Perforationen von 0,3 % und noch gedeckte tiefe murale Läsionen (Target-sign, erhaltene Serosalamelle) von insgesamt 3 % beschrieben [38]. Mit zunehmender Invasivität steigt das Risiko weiter an und erreicht bei einer kolorektalen ESD eine Inzidenz von 5 % bis zu 16 % [42][43][44]. Auch bei der ERCP besteht ein relativ hohes Perforationsrisiko in der Größenordnung von etwa 1 %, vor allem bei Ausführung einer Papillotomie [21,22,45].…”

Section: Introductionunclassified

APP – Das Amberger Perforationsprojekt als Grundlage für die Etablierung eines Komplikationserfassungs- und Managementsystems (KEMS) in der Endoskopie

Decassian

Dauer

2019

Z Gastroenterol

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Zusammenfassung Hintergrund Zurzeit ist ein Paradigmenwechsel bei der Therapie der iatrogenen gastrointestinalen Perforation hin zu einer primär endoskopischen Versorgung festzustellen. Material und Methoden Alle Perforationen im Rahmen aller konsekutiven gastrointestinalen Endoskopien von 01.01.2014 bis 31.12.2017 im Klinikum St. Marien Amberg wurden erfasst, dokumentiert und evaluiert. Hausinterne SOPs zum Prozedere wurden erstellt und kommuniziert. Grundsätzlich wurde der primäre interventionell-endoskopische Perforationsverschluss angestrebt, stets im interdisziplinären Konsens mit der Viszeralchirurgie. Ergebnisse Es kam im Beobachtungszeitraum zu 24 Perforationen bei 18 627 konsekutiven Endoskopien (0,13 %). Fälle mit bildgebendem Nachweis freier Luft ohne erkennbare Perforation waren gleich häufig wie Perforationen (12 Post-Polypektomiesyndrome und 12 Ereignisse nach ERCP mit EPT). Die Diagnose der Perforation erfolgte zu 95,8 % (23/24) innerhalb 12 h (davon 20 bereits bei der Endoskopie). Die initiale Therapiemodalität war in jeweils 3 Fällen primär operativ bzw. primär konservativ und in 17 Fällen primär endoskopisch (4 × Clips, 10 × OTSC, 3 × SEMS). In 1 Fall wurde keine Therapie durchgeführt. Es war eine Letalität von 4,2 % (1/24) zu verzeichnen. In 3 Fällen war sekundär ein operatives Vorgehen erforderlich, sodass insgesamt in 25 % (6/24) eine chirurgische Therapie erfolgte. Die interventionell-endoskopische Therapie war technisch erfolgreich zu 94,1 % (16/17) bei einem klinischen Erfolg nach Perforationsverschluss von 87,5 % (14/16). Diskussion Das Konzept der interventionell-endoskopischen Therapie iatrogener Perforationen ist im klinischen Alltag sicher und erfolgreich umsetzbar. Entscheidende Erfolgsfaktoren sind die kurze Zeitspanne bis zum Verschluss der Perforation und der stets anzustrebende interdisziplinäre Konsens im Vorfeld der Therapie. Auf der Basis der Ergebnisse wurde ein umfassendes Komplikationserfassungs- und Managementsystem (KEMS) für die Endoskopie ab 2016 in unserer Klinik etabliert (integriert in das Befunderstellungssystem und das Klinikinformationssystem).

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“…It is difficult to determine the exact learning curve for colorectal ESD as most studies involve endoscopists already experienced in upper gastrointestinal ESD. However, training in ESD is feasible without significant prior experience of upper gastrointestinal ESD 119,120…”

Section: Introductionmentioning

confidence: 99%

Colorectal endoscopic submucosal dissection: patient selection and special considerations

Emmanuel¹,

Gulati²,

Burt³

et al. 2017

CEG

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Endoscopic submucosal dissection (ESD) enables en bloc resection of large complex colorectal superficial neoplastic lesions, resulting in very low rates of local recurrence, high-quality pathologic specimens for accurate histopathologic diagnosis and potentially curative treatment of early adenocarcinoma without resorting to major surgical resection. The safety and efficacy of the technique, which was pioneered in the upper gastrointestinal tract, has been established by the consistently impressive outcomes from expert centers in Japan and some other eastern countries. However, ESD is challenging to perform in the colorectum and there is a significant risk of complications, particularly in the early stages of the learning curve. Early studies from western centers raised concerns about the high complication rates, and the impressive results from Japanese centers were not replicated. As a result, many western endoscopists are skeptical about the role of ESD and few centers have incorporated the technique into their practice. Nevertheless, although the distribution of expertise, referral centers and modes of practice may differ in Japan and western countries, ESD has an important role and can be safely and effectively incorporated into western practice. Key to achieving this is meticulous lesion assessment and selection, appropriate referral to centers with the necessary expertise and experience and application of the appropriate technique individualized to the patient. This review discusses the advantages, risks and benefits of ESD to treat colorectal lesions and the importance of preprocedure lesion assessment and in vivo diagnosis and outlines a pragmatic rationale for appropriate lesion selection as well as the patient, technical and institutional factors that should be considered.

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The Feasibility of Performing Colorectal Endoscopic Submucosal Dissection Without Previous Experience in Performing Gastric Endoscopic Submucosal Dissection

Cited by 46 publications

References 44 publications

Feasibility of colorectal endoscopic submucosal dissection (ESD) carried out by endoscopists with no or little experience in gastric ESD

Feasibility of colorectal endoscopic submucosal dissection (ESD) carried out by endoscopists with no or little experience in gastric ESD

APP – Das Amberger Perforationsprojekt als Grundlage für die Etablierung eines Komplikationserfassungs- und Managementsystems (KEMS) in der Endoskopie

Colorectal endoscopic submucosal dissection: patient selection and special considerations

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