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Published in:

01-05-2010

Difficulties and outcomes in starting endoscopic submucosal dissection

Authors: Anthony Yuen Bun Teoh, Philip Wai Yan Chiu, Simon Kin Hung Wong, Joseph Jao Yiu Sung, James Yun Wong Lau, Enders Kwok Wai Ng

Published in: Surgical Endoscopy | Issue 5/2010

Abstract

Background

Endoscopic submucosal dissection (ESD) is a technically demanding procedure associated with a higher risk of complications. This study aimed to assess the difficulties and outcomes experienced by endoscopists beginning to perform ESD.

Methods

This prospective study investigated course participants in an ESD training workshop. The participants were asked at the end of the workshop about the ease of using various ESD knives, the occurrence of complications and their management, the procedural time, and the outcomes for the swine used for the procedure.

Results

For this study, 24 endoscopists were trained in performing gastric and esophageal ESD techniques using a porcine model. The mean size of the specimen retrieved was 2.66 ± 1.18 cm. The mean procedural times were 52.09 ± 24.67 min for gastric ESD and 32.50 ± 8.45 min for esophageal ESD. During gastric ESD, 15 participants (65.22%) encountered perforations, whereas bleeding occurred during 13 ESDs (56.52%). There were two procedure-related mortalities. Significantly, a higher proportion of perforations were encountered with the use of noninsulated knives. The perforated and nonperforated groups did not show a difference in prior endoscopic experience (P = 0.335). The majority of the participants agreed that the swine model is appropriate for simulating both human gastric (96%) and esophageal (96%) ESD.

Conclusions

The ESD procedure is technically challenging and associated with a high rate of complications for beginners. The use of noninsulated knives may increase the risk of perforations during the learning curve for gastric ESD, and future prospective trials must evaluate their use. The development of training models may augment the acquisition of skills in low-volume centers but will not replace a standardized patient-based training program.

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Title: Difficulties and outcomes in starting endoscopic submucosal dissection
Authors: Anthony Yuen Bun Teoh
Philip Wai Yan Chiu
Simon Kin Hung Wong
Joseph Jao Yiu Sung
James Yun Wong Lau
Enders Kwok Wai Ng
Publication date: 01-05-2010
Publisher: Springer-Verlag
Published in: Surgical Endoscopy / Issue 5/2010
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-009-0724-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Difficulties and outcomes in starting endoscopic submucosal dissection

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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