Effectiveness of Strategy-Focused Training in Colorectal Endoscopic Submucosal Dissection: A Retrospective Observational Study
- 25.04.2024
- Original Article
Erschienen in:
- Verfasst von
- Hideyuki Chiba
- Ken Ohata
- Keiichi Ashikari
- Jun Tachikawa
- Naoya Okada
- Akimichi Hayashi
- Yu Ebisawa
- Mikio Kobayashi
- Jun Arimoto
- Hiroki Kuwabara
- Michiko Nakaoka
- Erschienen in
- Digestive Diseases and Sciences | Ausgabe 7/2024
Abstract
Background
Colorectal ESD, an advanced minimally invasive treatment, presents technical challenges, with globally varying training methods. We analyzed the learning curve of ESD training, emphasizing preoperative strategies, notably gravity traction, to guide ESD instructors and trainee programs.
Method
This retrospective study included 881 cases guided by an experienced supervisor. Six trainees received “strategy-focused” instruction. To evaluate the number of ESD experiences in steps, the following phases were classified based on ESD experiences of each trainees: Phase 0 (0–50 ESD), Phase 1 (51–100 ESD), Phase 2 (101–150 ESD), and Phase 3 (151–200 ESD). Lesion background, outcomes, and safety were compared across phases. Factors contributing to technical difficulty in early (Phase 0 and 1) and late phases (Phase 2 and 3) were identified, along with the utility of traction ESD with device assistance.
Result
Treatment outcomes were favorable, with 99.8% and 94.7% en bloc resection and curative resection rates, respectively. Approximately 90% self-completion rate could be achieved after experiencing about 50 cases (92.7% in Phase 1), signifying proficiency growth despite increased case difficulty. In early phases, factors such as left-sided colon, LST-NG morphology, and severe fibrosis pose challenges. In late phases, LST-NG morphology, mild and severe fibrosis remained significant. Traction-assisted ESD, utilized in 3% of cases, comprised planned (1.1%) and rescue (1.9%) methods. Planned traction aided specific lesions, while rescue traction was common in the right colon.
Conclusion
“Strategy-focused” ESD training consistently yields successful outcomes, effectively adapting to varying difficulty factors in different proficient stages.
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- Titel
- Effectiveness of Strategy-Focused Training in Colorectal Endoscopic Submucosal Dissection: A Retrospective Observational Study
- Verfasst von
-
Hideyuki Chiba
Ken Ohata
Keiichi Ashikari
Jun Tachikawa
Naoya Okada
Akimichi Hayashi
Yu Ebisawa
Mikio Kobayashi
Jun Arimoto
Hiroki Kuwabara
Michiko Nakaoka
- Publikationsdatum
- 25.04.2024
- Verlag
- Springer US
- Erschienen in
-
Digestive Diseases and Sciences / Ausgabe 7/2024
Print ISSN: 0163-2116
Elektronische ISSN: 1573-2568 - DOI
- https://doi.org/10.1007/s10620-024-08430-9
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