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Untutored training pathway to achieve competence in esophagogastric endoscopic submucosal dissection in a Western center.

Accepted version
Peer-reviewed

Type

Article

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Authors

Hadjinicolaou, Andreas V 
Pappas, Apostolos 
Sujendran, Vijay 
Kakhandki, Vibhay 
Abe, Seiichiro 

Abstract

BACKGROUND AND AIMS: Endoscopic submucosal dissection (ESD) has a long learning curve. The aim of this study was to assess the efficacy of an ESD unsupervised training model for experienced endoscopists. METHODS: Stepwise training included a visit to a high-volume center, unsupervised training on an ex vivo porcine model, and in vivo human upper GI cases with anatomic progression. Performance measures included en bloc resection, R0 resection, adverse event rates, and operating time. RESULTS: After observation of 30 esophagogastric ESDs and 15 untutored ex vivo ESDs, 5 human cases of distal gastric ESDs were performed, followed by 55 unselected esophagogastric cases. En bloc and R0 resection rates were 93.0% and 80.7%, respectively. Operating time was 14.0 min/cm2 in the stomach and 25.1 min/cm2 in the esophagus, with evidence of a learning curve for esophageal ESDs (first block 30.26 min/cm2 vs second block 14.81 min/cm2, P = .01). CONCLUSIONS: Untutored training for esophagogastric ESD is feasible and allows endoscopists, experienced in therapeutic endoscopy, to achieve the required standards toward competency.

Description

Keywords

Humans, Swine, Animals, Endoscopic Mucosal Resection, Esophagus, Dissection, Stomach

Journal Title

Gastrointest Endosc

Conference Name

Journal ISSN

0016-5107
1097-6779

Volume Title

Publisher

Elsevier BV
Sponsorship
National Institute for Health and Care Research (IS-BRC-1215-20014)