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25-04-2024 | Original Article

Effectiveness of Strategy-Focused Training in Colorectal Endoscopic Submucosal Dissection: A Retrospective Observational Study

Authors: Hideyuki Chiba, Ken Ohata, Keiichi Ashikari, Jun Tachikawa, Naoya Okada, Akimichi Hayashi, Yu Ebisawa, Mikio Kobayashi, Jun Arimoto, Hiroki Kuwabara, Michiko Nakaoka

Published in: Digestive Diseases and Sciences

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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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Literature
1.
go back to reference Ohata K, Kobayashi N, Sakai E et al. Long-term outcomes after endoscopic submucosal dissection for large colorectal epithelial neoplasms: a prospective, multicenter, cohort trial from Japan. Gastroenterology 2022;163:1423–1434.CrossRefPubMed Ohata K, Kobayashi N, Sakai E et al. Long-term outcomes after endoscopic submucosal dissection for large colorectal epithelial neoplasms: a prospective, multicenter, cohort trial from Japan. Gastroenterology 2022;163:1423–1434.CrossRefPubMed
2.
go back to reference Pimentel-Nunes P, Pioche M, Albéniz E et al. Curriculum for endoscopic submucosal dissection training in Europe: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy 2019;51:980–992.CrossRefPubMed Pimentel-Nunes P, Pioche M, Albéniz E et al. Curriculum for endoscopic submucosal dissection training in Europe: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy 2019;51:980–992.CrossRefPubMed
3.
go back to reference Draganov PV, Aihara H, Karasik MS et al. Endoscopic submucosal dissection in North America: a large prospective multicenter study. Gastroenterology 2021;160:2317–2327.CrossRefPubMed Draganov PV, Aihara H, Karasik MS et al. Endoscopic submucosal dissection in North America: a large prospective multicenter study. Gastroenterology 2021;160:2317–2327.CrossRefPubMed
4.
go back to reference Libânio D, Pimentel-Nunes P, Bastiaansen B et al. Endoscopic submucosal dissection techniques and technology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review. Endoscopy 2023;55:361–389.CrossRefPubMed Libânio D, Pimentel-Nunes P, Bastiaansen B et al. Endoscopic submucosal dissection techniques and technology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review. Endoscopy 2023;55:361–389.CrossRefPubMed
5.
go back to reference Mori H, Kobara H, Nishiyama N et al. Novel effective and repeatedly available ring-thread counter traction for safer colorectal endoscopic submucosal dissection. Surg Endosc 2017;31:3040–3047.CrossRefPubMed Mori H, Kobara H, Nishiyama N et al. Novel effective and repeatedly available ring-thread counter traction for safer colorectal endoscopic submucosal dissection. Surg Endosc 2017;31:3040–3047.CrossRefPubMed
6.
go back to reference Yamasaki Y, Takeuchi Y, Uedo N et al. Traction-assisted colonic endoscopic submucosal dissection using clip and line: a feasibility study. Endosc Int Open 2016;4:E51–E55.PubMed Yamasaki Y, Takeuchi Y, Uedo N et al. Traction-assisted colonic endoscopic submucosal dissection using clip and line: a feasibility study. Endosc Int Open 2016;4:E51–E55.PubMed
7.
go back to reference Takezawa T, Hayashi Y, Shinozaki S et al. The pocket-creation method facilitates colonic endoscopic submucosal dissection (with video). Gastrointest Endosc 2019;89:1045–1053.CrossRefPubMed Takezawa T, Hayashi Y, Shinozaki S et al. The pocket-creation method facilitates colonic endoscopic submucosal dissection (with video). Gastrointest Endosc 2019;89:1045–1053.CrossRefPubMed
8.
go back to reference Suzuki Y, Ohata K, Sakai E et al. Palisade technique as an effective endoscopic submucosal dissection tool for large colorectal tumors. Endosc Int Open 2021;9:E210–E215.CrossRefPubMedPubMedCentral Suzuki Y, Ohata K, Sakai E et al. Palisade technique as an effective endoscopic submucosal dissection tool for large colorectal tumors. Endosc Int Open 2021;9:E210–E215.CrossRefPubMedPubMedCentral
9.
go back to reference Hashiguchi Y, Muro K, Saito S et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) Guidelines 2019 for the treatment of colorectal cancer. Int J Clin Oncol 2020;25:1–42.CrossRefPubMed Hashiguchi Y, Muro K, Saito S et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) Guidelines 2019 for the treatment of colorectal cancer. Int J Clin Oncol 2020;25:1–42.CrossRefPubMed
10.
go back to reference Tanaka S, Kashida H, Saito Y et al. Japan Gastroenterological Endoscopy Society guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection. Dig Endosc 2020;32:219–223.CrossRefPubMed Tanaka S, Kashida H, Saito Y et al. Japan Gastroenterological Endoscopy Society guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection. Dig Endosc 2020;32:219–223.CrossRefPubMed
11.
go back to reference Matsuda T, Fujii T, Saito Y et al. Efficacy of the invasive/non-invasive pattern by magnifying chromoendoscopy to estimate the depth of invasion of early colorectal neoplasms. Am J Gastroenterol 2008;103:2700–2706.CrossRefPubMed Matsuda T, Fujii T, Saito Y et al. Efficacy of the invasive/non-invasive pattern by magnifying chromoendoscopy to estimate the depth of invasion of early colorectal neoplasms. Am J Gastroenterol 2008;103:2700–2706.CrossRefPubMed
12.
go back to reference Zhang X, Ly EK, Nithyanand S et al. Learning curve for endoscopic submucosal dissection with an untutored, prevalence-based approach in the United States. Clin Gastroenterol Hepatol 2020;18:580–588.CrossRefPubMed Zhang X, Ly EK, Nithyanand S et al. Learning curve for endoscopic submucosal dissection with an untutored, prevalence-based approach in the United States. Clin Gastroenterol Hepatol 2020;18:580–588.CrossRefPubMed
13.
go back to reference Zhang H, Chen L, Wang Z et al. The learning curve for robotic McKeown esophagectomy in patients with esophageal cancer. Ann Thorac Surg 2018;105:1024–1030.CrossRefPubMed Zhang H, Chen L, Wang Z et al. The learning curve for robotic McKeown esophagectomy in patients with esophageal cancer. Ann Thorac Surg 2018;105:1024–1030.CrossRefPubMed
14.
go back to reference Zhou J, Shi Y, Qian F et al. Cumulative summation analysis of learning curve for robot-assisted gastrectomy in gastric cancer. J Surg Oncol 2015;111:760–767.CrossRefPubMed Zhou J, Shi Y, Qian F et al. Cumulative summation analysis of learning curve for robot-assisted gastrectomy in gastric cancer. J Surg Oncol 2015;111:760–767.CrossRefPubMed
15.
go back to reference Ozeki Y, Hirasawa K, Sawada A et al. Learning curve analysis for duodenal endoscopic submucosal dissection: a single-operator experience. J Gastroenterol Hepatol 2022;37:2131–2137.CrossRefPubMed Ozeki Y, Hirasawa K, Sawada A et al. Learning curve analysis for duodenal endoscopic submucosal dissection: a single-operator experience. J Gastroenterol Hepatol 2022;37:2131–2137.CrossRefPubMed
16.
go back to reference Matsumoto A, Tanaka S, Oba S et al. Outcome of endoscopic submucosal dissection for colorectal tumors accompanied by fibrosis. Scand J Gastroenterol 2010;45:1329–1337.CrossRefPubMed Matsumoto A, Tanaka S, Oba S et al. Outcome of endoscopic submucosal dissection for colorectal tumors accompanied by fibrosis. Scand J Gastroenterol 2010;45:1329–1337.CrossRefPubMed
17.
go back to reference Arimoto J, Higurashi T, Kato S et al. Risk factors for post-colorectal endoscopic submucosal dissection (ESD) coagulation syndrome: a multicenter, prospective, observational study. Endosc Int Open 2018;6:E342–E349.CrossRefPubMedPubMedCentral Arimoto J, Higurashi T, Kato S et al. Risk factors for post-colorectal endoscopic submucosal dissection (ESD) coagulation syndrome: a multicenter, prospective, observational study. Endosc Int Open 2018;6:E342–E349.CrossRefPubMedPubMedCentral
18.
go back to reference Ohata K, Ito T, Chiba H et al. Effective training system in colorectal endoscopic submucosal dissection. Dig Endosc 2012;24:84–89.CrossRefPubMed Ohata K, Ito T, Chiba H et al. Effective training system in colorectal endoscopic submucosal dissection. Dig Endosc 2012;24:84–89.CrossRefPubMed
19.
go back to reference Hotta K, Oyama T, Shinohara T et al. Learning curve for endoscopic submucosal dissection of large colorectal tumors. Dig Endosc 2010;22:302–306.CrossRefPubMed Hotta K, Oyama T, Shinohara T et al. Learning curve for endoscopic submucosal dissection of large colorectal tumors. Dig Endosc 2010;22:302–306.CrossRefPubMed
20.
go back to reference Maselli R, Iacopini F, Azzolini F et al. Endoscopic submucosal dissection: Italian national survey on current practices, training and outcomes. Dig Liver Dis 2020;52:64–71.CrossRefPubMed Maselli R, Iacopini F, Azzolini F et al. Endoscopic submucosal dissection: Italian national survey on current practices, training and outcomes. Dig Liver Dis 2020;52:64–71.CrossRefPubMed
21.
go back to reference Wagner A, Neureiter D, Kiesslich T et al. Single-center implementation of endoscopic submucosal dissection (ESD) in the colorectum: low recurrence rate after intention-to-treat ESD. Dig Endosc 2018;30:354–363.CrossRefPubMed Wagner A, Neureiter D, Kiesslich T et al. Single-center implementation of endoscopic submucosal dissection (ESD) in the colorectum: low recurrence rate after intention-to-treat ESD. Dig Endosc 2018;30:354–363.CrossRefPubMed
22.
go back to reference Steinbrück I, Faiss S, Dumoulin FL et al. Learning curve of endoscopic submucosal dissection (ESD) with prevalence-based indication in unsupervised Western settings: a retrospective multicenter analysis. Surg Endosc 2023;37:2574–2586.CrossRefPubMed Steinbrück I, Faiss S, Dumoulin FL et al. Learning curve of endoscopic submucosal dissection (ESD) with prevalence-based indication in unsupervised Western settings: a retrospective multicenter analysis. Surg Endosc 2023;37:2574–2586.CrossRefPubMed
23.
go back to reference Mizushima T, Kato M, Iwanaga I et al. Technical difficulty according to location, and risk factors for perforation, in endoscopic submucosal dissection of colorectal tumors. Surg Endosc 2015;29:133–139.CrossRefPubMed Mizushima T, Kato M, Iwanaga I et al. Technical difficulty according to location, and risk factors for perforation, in endoscopic submucosal dissection of colorectal tumors. Surg Endosc 2015;29:133–139.CrossRefPubMed
24.
go back to reference Isomoto H, Nishiyama H, Yamaguchi N et al. Clinicopathological factors associated with clinical outcomes of endoscopic submucosal dissection for colorectal epithelial neoplasms. Endoscopy 2009;41:679–683.CrossRefPubMed Isomoto H, Nishiyama H, Yamaguchi N et al. Clinicopathological factors associated with clinical outcomes of endoscopic submucosal dissection for colorectal epithelial neoplasms. Endoscopy 2009;41:679–683.CrossRefPubMed
26.
go back to reference Boda K, Oka S, Tanaka S et al. Real-world learning curve analysis of colorectal endoscopic submucosal dissection: a large multicenter study. Surg Endosc 2020;34:3344–4335.CrossRefPubMed Boda K, Oka S, Tanaka S et al. Real-world learning curve analysis of colorectal endoscopic submucosal dissection: a large multicenter study. Surg Endosc 2020;34:3344–4335.CrossRefPubMed
27.
go back to reference Muramoto T, Ohata K, Sakai E et al. Endoscopic submucosal dissection for colorectal neoplasms in proximity or extending to a diverticulum. Surg Endosc 2021;35:3479–3487.CrossRefPubMed Muramoto T, Ohata K, Sakai E et al. Endoscopic submucosal dissection for colorectal neoplasms in proximity or extending to a diverticulum. Surg Endosc 2021;35:3479–3487.CrossRefPubMed
28.
go back to reference Tashima T, Ohata K, Nonaka K et al. Endoscopic submucosal dissection for laterally spreading tumors involving the appendiceal orifice. Surg Endosc 2017;31:5444–5450.CrossRefPubMed Tashima T, Ohata K, Nonaka K et al. Endoscopic submucosal dissection for laterally spreading tumors involving the appendiceal orifice. Surg Endosc 2017;31:5444–5450.CrossRefPubMed
Metadata
Title
Effectiveness of Strategy-Focused Training in Colorectal Endoscopic Submucosal Dissection: A Retrospective Observational Study
Authors
Hideyuki Chiba
Ken Ohata
Keiichi Ashikari
Jun Tachikawa
Naoya Okada
Akimichi Hayashi
Yu Ebisawa
Mikio Kobayashi
Jun Arimoto
Hiroki Kuwabara
Michiko Nakaoka
Publication date
25-04-2024
Publisher
Springer US
Published in
Digestive Diseases and Sciences
Print ISSN: 0163-2116
Electronic ISSN: 1573-2568
DOI
https://doi.org/10.1007/s10620-024-08430-9
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