The learning curve for EMR with circumferential mucosal incision in treating intramucosal gastric neoplasm

Choi, Il Ju; Kim, Chan Gyoo; Chang, Hee Jin; Kim, Sang Gyun; Kook, Myeong Cherl; Bae, Jae Moon

doi:10.1016/j.gie.2005.04.033

Cited by 142 publications

(113 citation statements)

References 12 publications

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“…However, technical problems and expansion of the eligibility criteria for ESD can also cause complications and can prolong surgical time [1,3,4]. Therefore, in order to perform ESD safely and satisfactorily, patients should be maintained under an appropriate anesthesia regimen or sedation during the entire period of the ESD.…”

Section: Introductionmentioning

confidence: 99%

“…DS is more frequently used than GA for ESD [3]. While endoscopic treatments performed in apparently unconscious patients under DS were assumed to have little invasive impact, DS sometimes appears to be insuffi cient in patients undergoing ESD for an extended time [1,3,4]. However, no objective assessment of the perioperative stress for patients during ESD has so far been conducted.…”

Section: Introductionmentioning

confidence: 99%

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Salivary amylase activity is useful for assessing perioperative stress in response to pain in patients undergoing endoscopic submucosal dissection of gastric tumors under deep sedation

et al. 2010

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Salivary amylase activity is useful for assessing perioperative stress in response to pain in patients undergoing endoscopic submucosal dissection of gastric tumors under deep sedation

et al. 2010

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“…ESD enables en-bloc complete resection of larger-sized, depressed-type with submucosal fibrosis or difficult-located EGC. But ESD has disadvantages of longer procedure time and higher complication rate in terms of bleeding or perforation rather than conventional EMR, and necessitates a longer learning curve and expertise (Choi IJ et al, 2005). Therefore, conventional EMR can be still applied for small-sized, polypoid-type EGC rather than ESD regarding to risk and benefit.…”

Section: Clinical Results Of Endoscopic Resection For Egcmentioning

confidence: 99%

Endoscopic Resection of Early Gastric Cancer

Kim¹

2011

Therapeutic Gastrointestinal Endoscopy

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“…It has been showed that when prior knowledge of advanced resection techniques is limited and no supervision by an expert in ESD is available, there is a learning curve in which not only the en-bloc resection rate and procedure duration improve with increasing experience but, more importantly, the perforation rate decreases too [33] .…”

Section: Esd Learning Curvementioning

confidence: 99%

“…Gotoda et al [34] found that experience of at least 30 cases is required for a beginner to gain early proficiency in this technique [34] . Choi et al [33] investigated the learning curve for ESD and reported an increase in the en-bloc resection rate from 45% to 85% after experience of 40 cases. They concluded that trainees need to perform 20-40 procedures to be able to use the technique effectively, although their method consisted of mucosal incision and snaring rather than standard ESD.…”

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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The learning curve for EMR with circumferential mucosal incision in treating intramucosal gastric neoplasm

Cited by 142 publications

References 12 publications

Salivary amylase activity is useful for assessing perioperative stress in response to pain in patients undergoing endoscopic submucosal dissection of gastric tumors under deep sedation

Salivary amylase activity is useful for assessing perioperative stress in response to pain in patients undergoing endoscopic submucosal dissection of gastric tumors under deep sedation

Endoscopic Resection of Early Gastric Cancer

Training in endoscopic submucosal dissection

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