Mo1779 CLINICAL ANALYSIS OF COLORECTAL ESD CARRIED OUT BY ENDOSCOPISTS LACKING EXPERIENCE IN GASTRIC ESD

Abstract

Objective: Colorectal endoscopic submucosal dissection (ESD) is now carried out mainly by endoscopists with sufficient experience in gastric ESD. However, the detection rate of early gastric carcinoma is still low in China and endoscopic maneuverability differs between the stomach and colorectum. The aim of this study was to assess the feasibility of colorectal ESD carried out by endoscopists with no or little experience in gastric ESD. A total of 120 colorectal ESD cases, composed of each endoscopist’s who had no or <5 cases of experience in gastric ESD first 60 consecutive cases, were retrospectively reviewed. The endoscopists who participated in the present study had completed over 3000 colonoscopy and 500 colorectal EMR. They had inspected and learned from other endoscopists’ ESD procedures for more than 50 cases and undergone training using resected pig stomachs to get experience of basic ESD skills. We analyzed demographic data of patients, characteristics of lesions, procedure time, complete resection rate, en bloc resection rate and complication rate, et al. All cases were divided into three groups: the first 20 cases of each endoscopist were in early phase group, 21-40 cases were in middle phase group and 41-60 cases were in late phase group. All data were compared among three groups. There were 65 (54.2%) male and 55 (45.8%) female in these 120 cases. The average age was 63.5±12.4 years old. The rate of LST (82/120,68.3%) and lesion in rectum (52/60, 43.3%) were the highest. The size of non-SMT group was 2.28±1.01 cm, while SMT lesions was 0.70±0.16 cm. The average procedural time was 60.5+61.7 min. The en bloc resection and complete resection rates were 74.2% and 71.7%, respectively. 1 case suffered from hemorrhage after ESD and 8 cases of perforation occurred during ESD. However, no patients needed endoscopy again or surgery. According to learning curve, procedural time was significant longer in early phase compared with middle and late phases(P=0.000). Other data did not have significant difference among early, middle and late phases (P>0.05). Endoscopists who lack experience in gastric ESD can carry out colorectal ESD safely based on rigorous training, including enough colonscopy cases, inspecting colorectal ESD and excercising using resected pig stomachs. The procedural time could be shorten after 20 cases.