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Surgical Endoscopy
Published in: Surgical Endoscopy 9/2017

01-09-2017

Learning curve and clinical outcome of gastric endoscopic submucosal dissection performed by trainee operators

Authors: Masao Yoshida, Naomi Kakushima, Keita Mori, Kimihiro Igarashi, Noboru Kawata, Masaki Tanaka, Kohei Takizawa, Sayo Ito, Kenichiro Imai, Kinichi Hotta, Hirotoshi Ishiwatari, Hiroyuki Matsubayashi, Hiroyuki Ono

Published in: Surgical Endoscopy | Issue 9/2017

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Abstract

Background

Although endoscopic submucosal dissection (ESD) represents a significant progress in therapeutic endoscopy, little is known about how trainees attain its technical proficiency. The aims of this study were to evaluate the learning curve and clinical outcomes of gastric ESD performed by trainee endoscopists.

Methods

Between April 2009 and March 2014, 334 gastric ESD procedures were performed by seven trainees (42–50 consecutive cases per trainee). The learning curve for gastric ESD was evaluated using the cumulative sum (CUSUM) method. Long-term outcomes were also analyzed.

Results

The calculated CUSUM learning curve comprised three phases: Phase I (the initial 15 cases), Phase II (the middle 15 cases), and Phase III (the final 20 cases). The resection speed was 5.7 ± 3.2 min/cm2 in Phase I, 4.7 ± 2.7 min/cm2 in Phase II, and 4.3 ± 2.2 min/cm2 in Phase III. The resection speed was significantly faster in Phase II than in Phase I (p = 0.019). The rate of self-completion reached more than 95% in Phases II and III. The overall complete resection rate was 95%, showing no significant differences between the three phases. Local recurrence was diagnosed in none of the patients during a median follow-up of 38 months.

Conclusions

For the trainees, 30 cases were required to attain a higher technical level of competence in gastric ESD. After the learning curve phase, trainee operators could be expected to complete the procedure successfully with favorable long-term outcomes.
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Metadata
Title
Learning curve and clinical outcome of gastric endoscopic submucosal dissection performed by trainee operators
Authors
Masao Yoshida
Naomi Kakushima
Keita Mori
Kimihiro Igarashi
Noboru Kawata
Masaki Tanaka
Kohei Takizawa
Sayo Ito
Kenichiro Imai
Kinichi Hotta
Hirotoshi Ishiwatari
Hiroyuki Matsubayashi
Hiroyuki Ono
Publication date
01-09-2017
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 9/2017
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-016-5393-9

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