Learning curve of endoscopic submucosal dissection (ESD) with prevalence-based indication in unsupervised Western settings: a retrospective multicenter analysis

Autor: Ingo, Steinbrück, Siegbert, Faiss, Franz Ludwig, Dumoulin, Tsuneo, Oyama, Jürgen, Pohl, Thomas, von Hahn, Arthur, Schmidt, Hans-Peter, Allgaier
Rok vydání: 2022
Předmět:
Zdroj: Surgical Endoscopy. 37:2574-2586
ISSN: 1432-2218
0930-2794
DOI: 10.1007/s00464-022-09742-5
Popis: As there is still no consensus about the adequate training strategy for ESD in Western countries, we evaluated unsupervised prevalence-based learning curves including detailed organ-specific subgroup analysis.The first 120 ESDs of four operators (n = 480) were divided into three groups (1: ESD 1-40, 2: ESD 41-80, 3: ESD 81-120). Outcome parameters were rates of technical success, en bloc and R0 resection, the resection speed, rates of conversion to EMR, curative resection, adverse events, surgery due to adverse events, and recurrence. In addition, we analyzed the achievement of quality benchmarks indicating levels of expertise.After exclusion of pretreated lesions, 438 procedures were enrolled in the final analysis. Technical success rates were 96% with significant improvements regarding rate of en bloc resection (from 82.6 to 91.2%), resection speed (from 4.54 to 7.63 cmThis trial confirms safety and feasibility of unsupervised ESD along the initial learning curve with prevalence-based indication and exclusion of colonic cases.
Databáze: OpenAIRE
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