Learning to perform endoscopic resection of esophageal neoplasia is associated with significant complications even within a structured training program
| Autor: | R. E. Pouw, Lorenza Alvarez Herrero, M. H. M. G. Houben, F. J. W. Ten Kate, Femke P. Peters, B.E. Schenk, Jjghm Bergman, Frans Peters, B. L. A. M. Weusten, Paul Fockens, Mike Visser, EJ Schoon, F. G. I. van Vilsteren, Raf Bisschops |
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| Přispěvatelé: | Pediatric Surgery, Pathology, Gastroenterology and hepatology, CCA - Cancer Treatment and quality of life, CCA - Imaging and biomarkers, Amsterdam Gastroenterology Endocrinology Metabolism, Faculteit Medische Wetenschappen/UMCG, Other departments, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, CCA -Cancer Center Amsterdam, Gastroenterology and Hepatology |
| Rok vydání: | 2012 |
| Předmět: |
Male
Esophageal Neoplasms Swine Radiofrequency ablation ERADICATION medicine.medical_treatment MUCOSAL RESECTION Endoscopic mucosal resection law.invention Interquartile range law Intraepithelial neoplasia medicine.diagnostic_test Gastroenterology Middle Aged CANCER Treatment Outcome MULTIBAND MUCOSECTOMY medicine.anatomical_structure Esophagectomy HIGH-GRADE DYSPLASIA Carcinoma Squamous Cell Female Clinical Competence Esophagoscopy Gastrointestinal Hemorrhage Learning Curve medicine.medical_specialty Perforation (oil well) Barrett Esophagus Esophagus SDG 3 - Good Health and Well-being medicine Animals Humans RADIOFREQUENCY ABLATION Aged Esophageal Perforation Mucous Membrane business.industry General surgery FOCAL ABLATION INTRAMUCOSAL CARCINOMA Surgery Endoscopy EARLY BARRETTS NEOPLASIA INTRAEPITHELIAL NEOPLASIA Education Medical Graduate business |
| Zdroj: | Endoscopy, 44(1), 4-12. Georg Thieme Verlag Van Vilsteren, F G I, Pouw, R E, Herrero, L A, Peters, F P, Bisschops, R, Houben, M, Peters, F T M, Schenk, B E, Weusten, B L A M, Visser, M, Ten Kate, F J W, Fockens, P, Schoon, E J & Bergman, J J G H M 2012, ' Learning to perform endoscopic resection of esophageal neoplasia is associated with significant complications even within a structured training program ', Endoscopy, vol. 44, no. 1, pp. 4-14 . https://doi.org/10.1055/s-0031-1291384 Endoscopy, 44(1), 4-14. Georg Thieme Verlag Endoscopy, 44(1), 4-12. GEORG THIEME VERLAG KG |
| ISSN: | 0013-726X |
| DOI: | 10.1055/s-0031-1291384 |
| Popis: | Background and study aims: Endoscopic resection is the cornerstone of endoscopic treatment of esophageal high grade dysplasia or early cancer. Endoscopic resection is, however, a technically demanding procedure, which requires training and expertise. The aim of the current study was to prospectively evaluate efficacy and safety of the first 120 endoscopic resection procedures of early esophageal neoplasia performed by six endoscopists (20 endoscopic resections each) who were participating in an endoscopic resection training program.Patients and methods: The program consisted of four tri-monthly 1-day courses with lectures, live-demonstrations, hands-on training on anesthetized pigs, and one-on-one hands-on training days. Gastroenterologists from centers with multidisciplinary expertise in upper gastrointestinal oncology participated, together with an endoscopy nurse and a pathologist. Outcome measures were complete endoscopic removal of the target area and acute complications.Results: A total of 120 consecutive esophageal endoscopic resection procedures (85 ER-cap, 35 multiband mucosectomy [MBM]) were performed by six endoscopists: 109 in Barrett's esophagus, 11 for squamous neoplasia; 85 piecemeal endoscopic resections (median 3 specimens, interquartile range 2-4 specimens). Complete endoscopic removal was achieved in 111/120 cases (92.5%). Six perforations occurred (5.0%): five were effectively treated endoscopically (clips, covered stent), and one patient underwent esophagectomy. There were 11 acute mild bleedings (9.2%), which were managed endoscopically. Perforations occurred in ER-cap procedures performed by four participants (7.1% ER-cap vs. 0% MBM; P = 0.18), and in 1.7% of the first 10 endoscopic resections and 8.3% of the second 10 endoscopic resections per endoscopist (P = 0.26).Conclusion: In this intense, structured training program, the first 120 esophageal endoscopic resections performed by six participants were associated with a 5.0% perforation rate. Although perforations were adequately managed, performing 20 endoscopic resections may not be sufficient to reach the peak of the learning curve in endoscopic resection. |
| Databáze: | OpenAIRE |
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