Tu1087 IS ENDOSCOPIC SUBMUCOSAL DISSECTION STILL LIMITED TO FEW TERTIARY CENTERS IN THE WEST? RESULTS FROM A NATIONAL SURVEY IN BRAZIL

Abstract

Endoscopic submucosal dissection (ESD) is carried out routinely in Asia and there has been a growing interest in both learning and practicing it among Western endoscopists. This study aimed to investigate the current clinical practice of ESD in Brazil by means of an electronic questionnaire elaborated by the Scientific Commission of the Brazilian Society of Digestive Endoscopy (SOBED). In October 2019, 3512 endoscopist members of SOBED were invited to respond to a National electronic survey containing 43 questions divided into 4 sections: operator identification and profile; clinical experience with ESD in humans; occurrence of adverse events and learning process/training in ESD. Informed consent was requested to all individuals for utilization of submitted answers in this study. The investigators reviewed all responses and considered valid if more than 50% of the questions were addressed and additional information, when requested, were provided by the endoscopist. A total of 444 individuals (12.6%) accessed the questionnaire and 376 responses were received (10.7%). After reviewing process, 221 responses were excluded (8 individuals denied consent, 203 presented incomplete responses and 10 did not provide requested additional information). In total 155 responses (4.4%) were considered valid and entered the study. ESD has been carried out all over the country in 22 of 26 Federation States and majority of respondents (32.2%) have 10 to 20 years of endoscopy practice. ESD procedures have been performed mainly in private hospitals (101 individuals, 66.9%) and private ambulatory centers (41 individuals, 27.1%). ESD has been practiced in public and university hospitals by 40 (26.4%) and 37 (24.5%) respondents, respectively. ESD was carried out mainly in the stomach (72%), followed by rectum (57%) and 80% of the individuals report less than 25 operations in humans. A total of 24 individuals experienced perforation during ESD (15.4 %) and 4 of them reported postoperative mortality (2.5%). Hands-on training in animal models was undertaken by 77.7% of the respondents. A similar proportion (76.7%) confirmed visiting referral centers in ESD as part of the training process, mostly within Brazil (71 respondents, 61.2%), followed by Japan (19 respondents, 16.3%). Only 16 respondents (10.3%) published scientific papers related to ESD. ESD appears to be practiced throughout Brazil, not only in tertiary or academic institutions and mainly in private practice, although the large majority of operators are still at the beginning of the learning curve. Gastric ESD leads the experience in Brazil, differently from other Western countries. Most ESD operators received training in animal models and visited referral centers. The reported outcomes in terms of complications and mortality rates appear to be similar to Eastern reports.