Abstract
Background and AimEndoscopic submucosal dissection (ESD) is a challenging procedure. A dissection speed of ≥9 cm2/h has been acknowledged as a mark for expertise, alongside a complication rate of ≤5% and en bloc resection rate of ≥90%. However, there is lack of objective information on whether the three measures correlate with each other. This study aims to evaluate the dissection speed, safety, and efficacy of colorectal ESDs performed by experts and trainees.MethodsConsecutive patients undergoing colorectal ESD at a Japanese hospital (2006–2017) were included in a prospectively collected database. Information on patient demographics, proceduralist, and intra‐/postprocedure data was retrieved. The primary outcome was the comparison in dissection speed. The secondary outcomes included differences in safety and efficacy. Log‐linear regression models adjusted for confounders (e.g. R0 resection) were used to assess the differences in dissection speed.ResultsFive hundred ninety procedures (514 patients) performed by 26 endoscopists were analyzed. Experts performed a higher number of difficult lesions (e.g. F2 fibrosis) but achieved higher dissection speed (10.3 vs 6.7 cm2/h). The difference was statistically significant for both unadjusted and adjusted models (P < 0.0001). The en bloc resection rates were similar for both groups (experts = 95.6%; trainees = 94.7%, P = 0.61). Although nonexperts damaged more of the muscularis propria (18.6 vs 12.5%, P = 0.04), this did not translate into a significant difference in perforation (experts = 3.7%; trainees = 6.9%, P = 0.09) or delayed bleeding (experts = 2.9%; trainees = 4.4%, P = 0.34). The dissection speed steadily increased with expertise.ConclusionAlthough dissection speed for colorectal ESD was significantly higher for experts, ESDs could be safely and efficaciously performed by ESD trainees.
Highlights
Endoscopic resection is the current gold standard for treatment of precancerous and early cancerous lesions within the gastrointestinal tract
As proposed by Oyama et al, we investigated the evolution of dissection speed, safety, and efficacy throughout the process
We have arbitrarily adopted 16 as the number of colorectal endoscopic submucosal dissection (ESD) performed to be allocated into the “expert group.”
Summary
Endoscopic resection is the current gold standard for treatment of precancerous and early cancerous lesions within the gastrointestinal tract. For lesions involving superficial submucosa, guidelines from both West and East advise on the use of endoscopic submucosal dissection (ESD).[1,2,3,4]. This study aims to evaluate the dissection speed, safety, and efficacy of colorectal ESDs performed by experts and trainees. Log-linear regression models adjusted for confounders (e.g. R0 resection) were used to assess the differences in dissection speed. Conclusion: dissection speed for colorectal ESD was significantly higher for experts, ESDs could be safely and efficaciously performed by ESD trainees
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