Original articleClinical endoscopyStepwise training in rectal and colonic endoscopic submucosal dissection with differentiated learning curves
Section snippets
Study population
Patients with superficial neoplastic colorectal lesions referred to a nonacademic hospital were prospectively included to undergo an attempt of resection by ESD. Inclusion criteria were (1) lesions 20 mm or larger classified as sessile polyps, granular and nongranular LSTs, with or without a depressed area, in which en bloc EMR is difficult and ESD is recommended5; and (2) absent or superficial sm invasion estimated by white-light endoscopy and chromoscopy with 0.4% indigo carmine according to
Results
The operative training started in March 2009, and removal of 30 rectal and 30 colonic superficial lesions was attempted by ESD in an equal number of patients up to February 2012. Among lesions evaluated for inclusion in the study, 6 were referred to surgery because of endoscopic features of deep invasion and a positive no-lifting sign.
The patients' median age was 68 years (range 50-85 years), there were 19 (32%) female patients, antiplatelets and/or anticoagulants were withdrawn in 7 patients,
Discussion
The learning curve from the novice level to competent, proficient, and expert levels should be as steep as possible and supported by training protocols. Japanese expert opinion is that competence in ESD should be achieved in the distal stomach before moving to more difficult lesions and locations, with the colon as the final stage of this stepwise training.15, 16 The setting in Western countries is very unfavorable: early gastric cancer is less prevalent, and it is very difficult to accumulate
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2021, Gastrointestinal EndoscopyCitation Excerpt :Training programs may need to modify their program structure and/or duration to meet the specific needs and expectations of the trainee21 to incorporate ESD training. The reported number of cases required to achieve proficiency in ESD is also highly variable (ranging from 20 to 250 cases depending on the anatomic locations, definitions of proficiency, experience of trainees, and presence of proctors22-23), with most reports based on the personal learning curves of experienced endoscopists rather than training data. The core technical, nontechnical, and cognitive skills for training in ESD are listed in Table 1 and further discussed below.
DISCLOSURE: The authors disclosed no financial relationships relevant to this publication.
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