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Tawheed A, Ismail A, El-Kassas M, El-Fouly A, Madkour A. Endoscopic resection of gastrointestinal tumors: Training levels and professional roles explored. World J Gastrointest Oncol 2025; 17:101832. [PMID: 40235878 PMCID: PMC11995314 DOI: 10.4251/wjgo.v17.i4.101832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2024] [Revised: 01/26/2025] [Accepted: 02/11/2025] [Indexed: 03/25/2025] Open
Abstract
In this editorial, we provide commentary on a recently published study by Zhao et al in the World Journal of Gastrointestinal Oncology. The study discusses the clinical characteristics of patients undergoing endoscopic resection for gastric cancers. We feel it is important to engage our endoscopy community in a discussion on the current evidence in the literature on the necessary number of cases for training in endoluminal surgery techniques, particularly endoscopic submucosal dissection. This includes the latest recommendations from the European Society of Gastrointestinal Endoscopy, as well as a summary of key studies on the learning curve for these techniques. Additionally, we explore the impact of an endoscopist's specialty on endoscopy outcomes, drawing from current evidence in the literature to shape our perspective in this evolving field.
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Affiliation(s)
- Ahmed Tawheed
- Department of Endemic Medicine, Faculty of Medicine, Helwan University, Cairo 11795, Egypt
| | - Alaa Ismail
- Faculty of Medicine, Helwan University, Cairo 11795, Egypt
| | - Mohamed El-Kassas
- Department of Endemic Medicine, Faculty of Medicine, Helwan University, Cairo 11795, Egypt
| | - Amr El-Fouly
- Department of Endemic Medicine, Faculty of Medicine, Helwan University, Cairo 11795, Egypt
| | - Ahmad Madkour
- Department of Endemic Medicine, Faculty of Medicine, Helwan University, Cairo 11795, Egypt
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Zheng L, Chen L, Xu B, Luo B, Wang F, Liu Z, Gao X, Zhou L, Chen J, Xie L, Hou Y, Li D, Wang W. Orthodontic Rubber Band Traction Improves Trainees' Learning Curve of Colorectal Endoscopic Submucosal Dissection: A Prospective Randomized Study. Am J Gastroenterol 2024:00000434-990000000-01464. [PMID: 39588971 DOI: 10.14309/ajg.0000000000003239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 11/07/2024] [Indexed: 11/27/2024]
Abstract
INTRODUCTION Colorectal endoscopic submucosal dissection (ESD) is a technically demanding operation with a long learning curve. The aim of this study was to determine whether orthodontic rubber band (ORB)-assisted colorectal ESD could improve the trainees' learning curve as it was shown to shorten colorectal ESD procedure time in trainees and experts. METHODS This prospective, randomized, controlled clinical study involved 178 patients who underwent colorectal ESD, randomly divided into trainee ORB-assisted ESD (Trainee ORB-ESD; n = 60), trainee conventional ESD (Trainee C-ESD; n = 57), and expert conventional ESD (Expert C-ESD; n = 61) groups. The main outcome was procedure time. RESULTS Per Protocol analysis showed a similar operative time in the trainee ORB-ESD and expert C-ESD groups, which was shorter than in the trainee C-ESD group [28.0 (21.0-35.0) and 25.0 (15.0-35.0) vs 41.0 (31.0-52.5) min; ( P < 0.001)]. The trainee ORB-ESD, trainee C-ESD, and expert C-ESD groups differed significantly in resection speed (11.35, 9.07, and 12.56 mm 2 /min, respectively), good visual field exposure rate (96.7%, 80.7%, and 93.4%), and muscle injury rate (5.0%, 17.5%, and 6.6%). However, the trainee ORB-ESD and expert C-ESD groups were similar in these measures, and all 3 groups were similar in adverse events, en bloc resection, R0 resection, and pathology rates. The cumulative sum suggested that the learning inflection point of the trainee ORB-ESD group was earlier than that of the trainee C-ESD group. DISCUSSION ORB-ESD shortened colorectal ESD procedure time and improved efficiency in trainees to an expert level. ORB-ESD could shorten the learning curve, justifying its widespread application.
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Affiliation(s)
- Linfu Zheng
- Department of Gastroenterology, Fuzhou General Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Gastroenterology, 900TH Hospital of Joint Logistics SupportForce, Fuzhou, China
- Department of Gastroenterology, Oriental Hospital Affiliated to Xiamen University, Fuzhou, China
| | - Longping Chen
- Department of Gastroenterology, Fuzhou General Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Gastroenterology, 900TH Hospital of Joint Logistics SupportForce, Fuzhou, China
- Department of Gastroenterology, Oriental Hospital Affiliated to Xiamen University, Fuzhou, China
| | - Binbin Xu
- Department of Gastroenterology, Fuzhou General Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Gastroenterology, 900TH Hospital of Joint Logistics SupportForce, Fuzhou, China
- Department of Gastroenterology, Oriental Hospital Affiliated to Xiamen University, Fuzhou, China
| | - Baoxiang Luo
- Department of Gastroenterology, Fuzhou General Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Fuqiang Wang
- Department of Gastroenterology, Fuzhou General Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Zhilin Liu
- Department of Gastroenterology, Fuzhou General Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Xingjie Gao
- Department of Gastroenterology, Fuzhou General Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Linxin Zhou
- Department of Gastroenterology, Fuzhou General Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Jiawei Chen
- Department of Gastroenterology, Fuzhou General Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Gastroenterology, 900TH Hospital of Joint Logistics SupportForce, Fuzhou, China
- Department of Gastroenterology, Oriental Hospital Affiliated to Xiamen University, Fuzhou, China
| | - Longke Xie
- Department of Gastroenterology, Fuzhou General Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Gastroenterology, 900TH Hospital of Joint Logistics SupportForce, Fuzhou, China
- Department of Gastroenterology, Oriental Hospital Affiliated to Xiamen University, Fuzhou, China
| | - Yaping Hou
- Department of Gastroenterology, Fuzhou General Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Gastroenterology, 900TH Hospital of Joint Logistics SupportForce, Fuzhou, China
- Department of Gastroenterology, Oriental Hospital Affiliated to Xiamen University, Fuzhou, China
| | - Dazhou Li
- Department of Gastroenterology, Fuzhou General Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Gastroenterology, 900TH Hospital of Joint Logistics SupportForce, Fuzhou, China
- Department of Gastroenterology, Oriental Hospital Affiliated to Xiamen University, Fuzhou, China
| | - Wen Wang
- Department of Gastroenterology, Fuzhou General Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Gastroenterology, 900TH Hospital of Joint Logistics SupportForce, Fuzhou, China
- Department of Gastroenterology, Oriental Hospital Affiliated to Xiamen University, Fuzhou, China
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Masunaga T, Sasaki M, Sato M, Minezaki D, Morioka K, Tojo A, Sakurai H, Iwata K, Miyazaki K, Kubosawa Y, Mizutani M, Akimoto T, Takatori Y, Kawasaki S, Matsuura N, Nakayama A, Sujino T, Takabayashi K, Yahagi N, Nakajima K, Kato M. Intraoperative bleeding model for swine gastric endoscopic submucosal dissection via heparinization. Endosc Int Open 2024; 12:E1360-E1365. [PMID: 39610944 PMCID: PMC11604307 DOI: 10.1055/a-2411-9979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 09/09/2024] [Indexed: 11/30/2024] Open
Abstract
Background and study aims: Live swine have a high degree of coagulation and aggregation and using them for training about how to manage intraoperative bleeding during endoscopic submucosal dissection (ESD) is unsatisfactory. This study aimed to identify the appropriate heparin dose in an intraoperative bleeding model and validate its applicability. Methods: First, we explored the dose of heparin required for a swine bleeding model in which the activated clotting time reached and maintained the upper limit of measurement (1500 s) after 10 minutes. Second, we compared intraoperative bleeding and hematoma frequency during ESD for 2-cm lesions between the heparinized bleeding model and control groups. Intraoperative bleeding was classified according to the Forrest classification. Results: The combination of a bolus (300 U/kg), continuous infusion (300 U/kg/h), and a bolus dose (150 U/kg) of heparin 10 minutes after the first infusion was identified as the dose for the bleeding model. Five ESDs were performed in each heparinized bleeding model and the control group. The median number of intraoperative bleeds was significantly higher in the heparinized model than in the control group (5 interquartile range [IQR] 4-7 vs. 3 [IQR 0-4, P = 0.028). All of the intraoperative bleeding events oozing (Forrest Ib) rather than spurting (Forrest Ia). The median number of hematomas was significantly higher in the heparinized model group than in the control group (3 [IQR 1-4] vs. 0 [IQR 0-1], P = 0.023). Conclusions: High doses of heparin significantly increased intraoperative bleeding and hematoma during swine ESD.
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Affiliation(s)
- Teppei Masunaga
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Motoki Sasaki
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Moe Sato
- Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo, Japan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Daisuke Minezaki
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Kohei Morioka
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Anna Tojo
- Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo, Japan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Hinako Sakurai
- Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo, Japan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Kentaro Iwata
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Kurato Miyazaki
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yoko Kubosawa
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Mari Mizutani
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Teppei Akimoto
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Yusaku Takatori
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Shintaro Kawasaki
- Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo, Japan
| | - Noriko Matsuura
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Atsushi Nakayama
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Tomohisa Sujino
- Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo, Japan
| | - Kaoru Takabayashi
- Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo, Japan
| | - Naohisa Yahagi
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Kiyokazu Nakajima
- Department of Next Generation Endoscopic Intervention (Project ENGINE), Osaka University Graduate School of Medicine, Osaka, Japan
| | - Motohiko Kato
- Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo, Japan
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Mitra N, Whelan RL. A System for Teaching Advanced Colonoscopic Skills and Endoscopic Submucosal Dissection Based on Nonclinical Models. Clin Colon Rectal Surg 2024; 37:328-339. [PMID: 39132195 PMCID: PMC11309800 DOI: 10.1055/s-0043-1770947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
Endoscopic submucosal dissection (ESD) requires skills that the vast majority of endoscopists do not possess. ESD be broken down into component skills and at least three of the necessary skill sets can be taught separately. In the United States most trainees initially participate in half- or full-day courses that utilize ex vivo and in vivo animal models and the great majority learn these advanced skills in the clinical setting. We describe a comprehensive training over a well-defined period using ex vivo porcine or bovine large bowel models. There are five components or modules that make up the training program: (1) bowel wall injections in ex vivo tissue, (2) inanimate figure tracing model to teach scope control, (3) ESD in plastic tube with window cutout over which square of ex vivo tissue is placed, (4) ESD in ex vivo porcine or bovine large bowel, and (5) mucosal wound closure. The authors are in the midst of training a group of residents, fellows, and young attendings using this approach. This approach has not been vetted yet; however, the preliminary results are promising.
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Affiliation(s)
- Neil Mitra
- Department of Surgery, Lenox Hill Hospital, Northwell Health, New York
| | - Richard L. Whelan
- Department of Surgery, Lenox Hill Hospital, Northwell Health, New York
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Ueda H, Misumi Y, Nonaka K. Development of a colonic endoscopic submucosal dissection training model that simulates respiratory movements. Dig Endosc 2024; 36:855-856. [PMID: 38747264 DOI: 10.1111/den.14818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 04/17/2024] [Indexed: 07/13/2024]
Abstract
Watch a video of this article.
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Affiliation(s)
- Hiroki Ueda
- Department of Digestive Endoscopy, Tokyo Women's Medical University Hospital, Tokyo, Japan
- Department of Internal Medicine, National Defense Medical College, Saitama, Japan
| | - Yoshitsugu Misumi
- Department of Digestive Endoscopy, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Kouichi Nonaka
- Department of Digestive Endoscopy, Tokyo Women's Medical University Hospital, Tokyo, Japan
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Mitsui T, Sunakawa H, Yoda Y, Nishio M, Kondo S, Hamanaka J, Tokoro C, Nakajo K, Maeda S, Yano T, Hirasawa K. Novel gastric endoscopic submucosal dissection training model enhances the endoscopic submucosal dissection skills of trainees: a multicenter comparative study. Surg Endosc 2024; 38:3088-3095. [PMID: 38619558 DOI: 10.1007/s00464-024-10838-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/25/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) requires high endoscopic technical skills, and trainees should develop effective training methods. In collaboration with KOTOBUKI Medical, we developed the G-Master, which is a non-animal training model that can simulate various parts of gastric ESD. We aimed to clarify the usefulness of the G-Master for inexperienced ESD trainees. METHODS We collected data from the first 5 gastric ESD cases conducted by 15 inexperienced ESD trainees at 5 participating centers between 2018 and 2022. The participants were divided into two groups: the G-Master training and non-G-Master training groups. Outcome measurements, such as procedural speed, perforation rate, self-completion rate, and en bloc resection rate, were compared between the two groups retrospectively. RESULTS A total of 75 gastric ESD cases were included in this study. The G-Master training group included 25 cases performed by 5 trainees, whereas the non-G-Master training group included 50 cases performed by 10 trainees. The median procedural speed for all cases was significantly faster in the G-Master training group than in the non-G-Master training group. Moreover, the procedural speed was linearly improved from the initial to the last cases in the lower location in the G-Master training group compared with the non-G-Master training group. In addition, although there was no significant difference, the G-Master training group showed lower rates of perforation and a lesser need to transition to expert operators than the non-G-Master training group. CONCLUSION The G-Master could improve the ESD skills of inexperienced ESD trainees.
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Affiliation(s)
- Tomohiro Mitsui
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
- Division of Endoscopy, Saitama Cancer Center, Saitama, Japan
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Hironori Sunakawa
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.
- NEXT Medical Device Innovation Center, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
| | - Yusuke Yoda
- Division of Endoscopy, Saitama Cancer Center, Saitama, Japan
| | - Masafumi Nishio
- Division of Endoscopy, Yokohama City University Medical Center, Kanagawa, Japan
| | - Shinpei Kondo
- Department of Gastroenterology, Fujisawa City Hospital, Kanagawa, Japan
| | - Jun Hamanaka
- Department of Gastroenterology, Yokohama Minami Kyosai Hospital, Kanagawa, Japan
| | - Chikako Tokoro
- Department of Gastroenterology, Saiseikai Yokohamashi Nannbu Hospital, Kanagawa, Japan
| | - Keiichiro Nakajo
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Shin Maeda
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Tomonori Yano
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
- NEXT Medical Device Innovation Center, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Kingo Hirasawa
- Division of Endoscopy, Yokohama City University Medical Center, Kanagawa, Japan
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Masunaga T, Kato M, Sasaki M, Iwata K, Miyazaki K, Kubosawa Y, Mizutani M, Takatori Y, Matsuura N, Nakayama A, Takabayashi K, Yahagi N. Novel quantitative assessment indicators for efficiency and precision of endoscopic submucosal dissection in animal training models by analyzing an electrical surgical unit. Dig Endosc 2024; 36:19-27. [PMID: 37405690 DOI: 10.1111/den.14632] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 07/02/2023] [Indexed: 07/06/2023]
Abstract
OBJECTIVES Although endoscopic submucosal dissection (ESD) training is important, quantitative assessments have not been established. This study aimed to explore a novel quantitative assessment system by analyzing an electrical surgical unit (ESU). METHODS This was an ex vivo study. Step one: to identify the novel efficiency indicators, 20 endoscopists performed one ESD each, and we analyzed correlations between their resection speed and electrical status. Step two: to identify the novel precision indicators, three experts and three novices performed one ESD each, and we compared the stability of the electrical status. Step three: three novices in step two performed 19 additional ESDs, and we analyzed the learning curve using novel indicators. RESULTS Step one: the percentage of total activation time (AT) of ESU in the procedure time (β coefficient, 0.80; P < 0.01) and AT required for submucosal dissection (β coefficient, -0.57; P < 0.01) were significantly correlated with the resection speed. Step two: coefficient of variation of the AT per one pulse (0.16 [range, 0.13-0.17] vs. 0.26 [range, 0.20-0.41], P = 0.049) and coefficient of variation of the peak electric power per pulse during mucosal incision (0.14 [range, 0.080-0.15] vs. 0.25 [range, 0.24-0.28], P = 0.049) were significantly lower in the experts than in the novices. Regarding the learning curve, the percentage of total AT of ESU in the procedure time and AT required for submucosal dissection had a trend of improvement. CONCLUSION Novel indicators identified by analyzing ESU enable quantitative assessment for endoscopist's skill.
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Affiliation(s)
- Teppei Masunaga
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Motohiko Kato
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Motoki Sasaki
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Kentaro Iwata
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Kurato Miyazaki
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Yoko Kubosawa
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Mari Mizutani
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Yusaku Takatori
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Noriko Matsuura
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Atsushi Nakayama
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Kaoru Takabayashi
- Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo, Japan
| | - Naohisa Yahagi
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
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Lee DS, Lee GH, Kim SG, Lee KL, Kim JW, Jeong JB, Jung YJ, Kang HW. Usefulness of a new polyvinyl alcohol hydrogel (PVA-H)-based simulator for endoscopic submucosal dissection training: a pilot study. Clin Endosc 2023; 56:604-612. [PMID: 37524564 PMCID: PMC10565446 DOI: 10.5946/ce.2022.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 12/27/2022] [Accepted: 01/03/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND/AIMS We developed a new endoscopic submucosal dissection (ESD) simulator and evaluated its efficacy and realism for use training endoscopists. METHODS An ESD simulator was constructed using polyvinyl alcohol hydrogel sheets and compared to a previous ESD simulator. Between March 1, 2020, and December 30, 2021, eight expert endoscopists from three different centers analyzed the procedure-related factors of the simulator. Five trainees performed gastric ESD exercises under the guidance of these experts. RESULTS Although the two ESD simulators provided overall favorable outcomes in terms of ESD-related factors, the new simulator had several benefits, including better marking of the target lesion's limits (p<0.001) and overall handling (p<0.001). Trainees tested the usefulness of the new ESD simulator. The complete resection rate improved after 3 ESD training sessions (9 procedures), and the perforation rate decreased after 4 sessions (12 procedures). CONCLUSION We have developed a new ESD simulator that can help beginners achieve a high level of technical experience before performing real-time ESD procedures in patients.
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Affiliation(s)
- Dong Seok Lee
- Department of Gastroenterology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Gin Hyug Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Gyun Kim
- Department of Gastroenterology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Kook Lae Lee
- Department of Gastroenterology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Won Kim
- Department of Gastroenterology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Bong Jeong
- Department of Gastroenterology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Yong Jin Jung
- Department of Gastroenterology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Hyoun Woo Kang
- Department of Gastroenterology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
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Visrodia K, Dobashi A, Bazerbachi F, Poneros J, Sethi A. Endoscopic Submucosal Dissection Facilitating Techniques Among Non-experts: A Systematic Literature Review. Dig Dis Sci 2023; 68:2561-2584. [PMID: 37024739 DOI: 10.1007/s10620-022-07784-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 11/30/2022] [Indexed: 04/08/2023]
Abstract
BACKGROUND AND AIMS The dissemination of endoscopic submucosal dissection (ESD) has been limited by its technical complexity and safety profile, particularly among non-experts. Various techniques and devices have facilitated the performance of ESD, but their yield and role in the path to learning ESD remain unclear. METHODS We performed a systematic review by querying MEDLINE, EMBASE, Web of Science, and Japan Medical Abstracts Society specifically for comparative studies investigating the impact of assigned ESD techniques vs. conventional techniques among non-experts in ESD (< 50 ESD procedures). Procedural outcomes of efficacy, efficiency, and safety were assessed. RESULTS We identified 46 studies evaluating 54 cohorts in which a total 237 non-experts performed 2461 ESDs conventionally, and 1953 ESDs using an assigned ESD technique (knives, countertraction, miscellaneous techniques). The majority of studies were from East Asia (67%), single-center (96%), observational in design (61%), in an animal model (57%), and gastric location (63%). The most studied techniques were countertraction techniques (48% cohorts) and scissor knives (15% cohorts), both of which commonly enhanced efficiency of ESD, and less so efficacy or safety. Techniques found to be beneficial in experts were more likely to be beneficial in non-experts (70% concordance) than vice versa (47% concordance). CONCLUSION Based on the currently available literature, countertraction techniques and scissor knives should be considered for early incorporation into ESD training by non-experts. Several aspects of ESD training remain understudied, including techniques in Western non-experts, educational resources, and several commonly cited techniques. These areas should guide future investigation to enhance the pathway to learning ESD.
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Affiliation(s)
- Kavel Visrodia
- Division of Digestive and Liver Diseases, Columbia University Irving Medical Center-New York Presbyterian Hospital, 161 Fort Washington Ave, 8th Fl, Ste 852A, New York, NY, 10032, USA.
| | - Akira Dobashi
- Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
| | - Fateh Bazerbachi
- CentraCare, Interventional Endoscopy Program, St Cloud Hospital, St Cloud, MN, USA
| | - John Poneros
- Division of Digestive and Liver Diseases, Columbia University Irving Medical Center-New York Presbyterian Hospital, 161 Fort Washington Ave, 8th Fl, Ste 852A, New York, NY, 10032, USA
| | - Amrita Sethi
- Division of Digestive and Liver Diseases, Columbia University Irving Medical Center-New York Presbyterian Hospital, 161 Fort Washington Ave, 8th Fl, Ste 852A, New York, NY, 10032, USA
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10
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Simsek C, Aihara H. Training in Endoscopic Submucosal Dissection in the United States: The Current Paradigm. Gastrointest Endosc Clin N Am 2023; 33:41-53. [PMID: 36375885 DOI: 10.1016/j.giec.2022.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Endoscopic submucosal dissection (ESD) training in Japan is pursued through a designated master-apprentice, organ-based stepwise training model. However, applying a similar program to the United States is not a practical strategy due to the significant differences in the training system and disease prevalence. To incorporate the ESD training into the current advanced endoscopy fellowship program, the use of recently developed techniques and technologies to improve the efficiency of ESD is ideal. The ESD training program in the United States should be prevalence-based, with increased involvement of trainees depending on their objectively assessed competency levels.
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Affiliation(s)
- Cem Simsek
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Hiroyuki Aihara
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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11
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Uechi Y, Nonaka K, Misumi Y. Use of konjac in a novel colonic endoscopic submucosal dissection training model that is inexpensive and hygienic. Dig Endosc 2022; 34:e151-e152. [PMID: 35983715 DOI: 10.1111/den.14413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/25/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Yasuhiro Uechi
- Department of Digestive Endoscopy, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Kouichi Nonaka
- Department of Digestive Endoscopy, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Yoshitsugu Misumi
- Department of Digestive Endoscopy, Tokyo Women's Medical University Hospital, Tokyo, Japan
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12
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Chiba H, Ohata K, Tachikawa J, Yamada K, Okada N, Arimoto J, Ashikari K, Kuwabara H, Nakaoka M, Sakai E, Goto T. The feasibility of endoscopic submucosal dissection for colorectal lesions larger than 10 cm. Surg Endosc 2022; 36:5348-5355. [PMID: 34997339 DOI: 10.1007/s00464-021-08916-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 11/21/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Although endoscopic submucosal dissection (ESD) enables en bloc removal of colorectal neoplasms, its effectiveness for larger lesions (≥ 10 cm in diameter) is undetermined. We aimed to investigate the feasibility and safety of ESD for colorectal lesions ≥ 10 cm wide. METHODS This retrospective study included 3591 consecutive colorectal lesions managed with ESD from June 2012 through December 2020. Clinicopathological characteristics and treatment outcomes were compared between lesions ≥ 10 cm wide and lesions 5-10 cm wide. RESULTS There were 50 patients in the ≥ 10 cm group and 270 patients in the 5-10 cm group. Among patients in the ≥ 10 cm group, lesions were most often in the rectum (50.0%), and the laterally spreading tumor-granular nodular mixed type (LST-G-M) was most prevalent (41/50, 82%). Although patients in the ≥ 10 cm group a longer mean ESD procedure time (186.0 vs. 94.4 min, p < 0.001), the dissection speed was significantly higher in this group (0.50 vs. 0.41 cm2/min, p = 0.003). The en bloc and curative resection rates were comparable between the ≥ 10 cm and 5-10 cm groups (100% vs. 99.6% and 86.0% vs. 88.5%, respectively). Although the stenosis rate was higher in the ≥ 10 cm group (4% vs. 0%), the delayed bleeding and perforation rates were similar between the two groups. CONCLUSIONS ESD for colorectal lesions ≥ 10 cm wide is feasible and curative, even though it is associated with higher technical difficulty and longer procedure times compared with ESD for smaller lesions (Number: UMIN 000044313).
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Affiliation(s)
- Hideyuki Chiba
- Department of Gastroenterology, Omori Red Cross Hospital, 4-30-1 Chuo, Ota-ku, Tokyo, 143-8527, Japan.
| | - Ken Ohata
- Department of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, 5-9-22 Higashi-Gotanda, Shinagawa-ku, Tokyo, 141-8625, Japan
| | - Jun Tachikawa
- Department of Gastroenterology, Omori Red Cross Hospital, 4-30-1 Chuo, Ota-ku, Tokyo, 143-8527, Japan
| | - Keiji Yamada
- Department of Gastroenterology, Omori Red Cross Hospital, 4-30-1 Chuo, Ota-ku, Tokyo, 143-8527, Japan
| | - Naoya Okada
- Department of Gastroenterology, Omori Red Cross Hospital, 4-30-1 Chuo, Ota-ku, Tokyo, 143-8527, Japan
| | - Jun Arimoto
- Department of Gastroenterology, Omori Red Cross Hospital, 4-30-1 Chuo, Ota-ku, Tokyo, 143-8527, Japan
| | - Keiichi Ashikari
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Hiroki Kuwabara
- Department of Gastroenterology, Omori Red Cross Hospital, 4-30-1 Chuo, Ota-ku, Tokyo, 143-8527, Japan
| | - Michiko Nakaoka
- Department of Gastroenterology, Omori Red Cross Hospital, 4-30-1 Chuo, Ota-ku, Tokyo, 143-8527, Japan
| | - Eiji Sakai
- Department of Gastroenterology, Yokohama Sakae Kyosai Hospital, 132 Katsura-cho, Sakae-ku, Yokohama, Kanagawa, 247-8581, Japan
| | - Toru Goto
- Department of Gastroenterology, Omori Red Cross Hospital, 4-30-1 Chuo, Ota-ku, Tokyo, 143-8527, Japan
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13
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Shinozaki K, Misumi Y, Nonaka K. Digestive endoscopic submucosal dissection training using konjac. Dig Endosc 2021; 33:871-872. [PMID: 33745164 DOI: 10.1111/den.13977] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Kanae Shinozaki
- Department of Digestive Endoscopy, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Yoshitsugu Misumi
- Department of Digestive Endoscopy, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Kouichi Nonaka
- Department of Digestive Endoscopy, Tokyo Women's Medical University Hospital, Tokyo, Japan
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14
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Misumi Y, Nonaka K. Prevention and Management of Complications and Education in Endoscopic Submucosal Dissection. J Clin Med 2021; 10:jcm10112511. [PMID: 34204078 PMCID: PMC8201364 DOI: 10.3390/jcm10112511] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 06/03/2021] [Accepted: 06/03/2021] [Indexed: 02/06/2023] Open
Abstract
Endoscopic submucosal dissection (ESD) is considered superior to endoscopic mucosal resection as an endoscopic resection because of its higher en bloc resection rate, but it is more difficult to perform. As ESD techniques have become more common, and the range of treatment by ESD has expanded, the number of possible complications has also increased, and endoscopists need to manage them. In this report, we will review the management of critical complications, such as hemorrhage, perforation, and stenosis, and we will also discuss educational methods for acquiring and improving ESD skills.
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15
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Ichijima R, Esaki M, Yamakawa S, Minoda Y, Suzuki S, Kusano C, Ikehara H, Gotoda T. Ex vivo porcine model study on the treatment outcomes of scissor-type knife versus needle-type knife in endoscopic submucosal dissection performed by trainees. BMC Surg 2020; 20:287. [PMID: 33213449 PMCID: PMC7678282 DOI: 10.1186/s12893-020-00955-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 11/12/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) for gastrointestinal neoplasms can be technically difficult for trainee endoscopists. Presently, there is no consensus for trainees to select the endo-knife type in ESD. Therefore, we conducted a comparison study of treatment outcomes between scissors-type and needle-type knives in ESD performed by trainees in an ex vivo porcine model. METHODS This study was conducted on trainee endoscopists who participated in ESD hands-on seminars held in August 2018 and September 2019. A total of 22 trainees from 13 institutions were divided into two groups according to their endoscopic experience. Under expert supervision, each trainee performed two ESDs in porcine models, namely, scissor-type knife (ESD-S) and needle-type knife (ESD-N). The efficacy and safety, including the procedure time and rates of self-completion, en bloc resection, and complications, were compared between ESD-S and ESD-N. In subgroup analysis, we also investigated the predictors associated with the difficulty of ESD for trainees using multivariate logistic regression analysis. RESULTS Eight trainees had an experience of over 1000 endoscopies (senior trainee: S-Trainee), whereas the others had an experience of less than 1000 endoscopies (junior trainee: J-Trainee). Among the S-Trainees, no significant differences were observed in any treatment outcome between ESD-S and ESD-N. Among the J-Trainees, the total procedure and mucosal incision times were significantly shorter in ESD-S than in ESD-N [total procedure time: 16.5 min (range 10.0-31.0) vs. 22.3 min (range 10.0-38.0), P = 0.018; circumferential incision time: 10.0 min (range 6-16) vs. 17.0 min (range 5.0-31.5); P = 0.019]. Regarding complications, muscular injury occurred in two patients during ESD-N performed by J-Trainees; however, no muscular injury occurred during ESD-S. In subgroup analysis, ESD-N was an independent predictive factor of difficult ESD (odds ratio 5.28, 95% confidence interval 1.25-22.30; P = 0.024). CONCLUSIONS This study revealed that trainees, particularly those who have experienced less than 1000 endoscopies, should opt for the scissor-type knife to perform ESD.
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Affiliation(s)
- Ryoji Ichijima
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, 1-6 Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-0062, Japan
| | - Mitsuru Esaki
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, 1-6 Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-0062, Japan.
- Department of Medicine and Bioregulatory Science, Graduate School of Medicine Sciences, Kyushu University, Fukuoka, Japan.
| | - Shun Yamakawa
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, 1-6 Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-0062, Japan
| | - Yosuke Minoda
- Department of Medicine and Bioregulatory Science, Graduate School of Medicine Sciences, Kyushu University, Fukuoka, Japan
| | - Sho Suzuki
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, 1-6 Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-0062, Japan
| | - Chika Kusano
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, 1-6 Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-0062, Japan
| | - Hisatomo Ikehara
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, 1-6 Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-0062, Japan
| | - Takuji Gotoda
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, 1-6 Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-0062, Japan
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16
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Rajendran A, Pannick S, Thomas-Gibson S, Oke S, Anele C, Sevdalis N, Haycock A. Systematic literature review of learning curves for colorectal polyp resection techniques in lower gastrointestinal endoscopy. Colorectal Dis 2020; 22:1085-1100. [PMID: 31925890 DOI: 10.1111/codi.14960] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 11/26/2019] [Indexed: 02/08/2023]
Abstract
AIM The performance of therapeutic procedures in lower gastrointestinal endoscopy (LGI) can be challenging and carries an increased risk of adverse events. There is increasing demand for the training of endoscopists in these procedures, but limited guidelines exist concerning procedural competency. The aim of this study was to assess the learning curves for LGI polypectomy, colorectal endoscopic mucosal resection (EMR) and colorectal endoscopic submucosal dissection (ESD). METHOD A systematic review of electronic databases between 1946 and September 2019 was performed. Citations were included if they reported learning curve data. Outcome measures that defined the success of procedural competency were also recorded. RESULTS A total of 34 out of 598 studies met the inclusion criteria of which 28 were related to ESD, three to polypectomy and three to EMR. Outcome measures for polypectomy competency (en bloc resection, delayed bleeding and independent polypectomy rate) were achieved after completion of between 250 and 400 polypectomies and after 300 colonoscopies. EMR outcome measures, including complete resection and recurrence, were achieved variably between 50 and 300 procedures. Outcome measures for ESD included efficiency (resection rates and procedural speed) and safety (adverse events). En bloc resection rates of over 80% and R0 resection rates of over 70% were achieved at 20-40 cases and procedural speed increased after 30 ESD cases. Competency in safety metrics was variably achieved at 20-200 cases. CONCLUSION There is a paucity of data on learning curves in LGI polypectomy, EMR and ESD. Despite limited evidence, we have identified relevant outcome measures and threshold numbers for the most common LGI polyp resection techniques for potential inclusion in training programmes/credentialing guidelines.
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Affiliation(s)
- A Rajendran
- The Wolfson Unit for Endoscopy, St Mark's Hospital, Harrow, UK.,Centre for Implementation Science, Health Service and Population Research Department, King's College London, London, UK.,Hillingdon Hospitals NHS Foundation Trust, Uxbridge, UK
| | - S Pannick
- Department of Surgery and Cancer, Imperial College, London, UK
| | - S Thomas-Gibson
- The Wolfson Unit for Endoscopy, St Mark's Hospital, Harrow, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | - S Oke
- Hillingdon Hospitals NHS Foundation Trust, Uxbridge, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | - C Anele
- Department of Surgery and Cancer, Imperial College, London, UK
| | - N Sevdalis
- Centre for Implementation Science, Health Service and Population Research Department, King's College London, London, UK
| | - A Haycock
- The Wolfson Unit for Endoscopy, St Mark's Hospital, Harrow, UK.,Department of Surgery and Cancer, Imperial College, London, UK
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17
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McCarty TR, Aihara H. Current state of education and training for endoscopic submucosal dissection: Translating strategy and success to the USA. Dig Endosc 2020; 32:851-860. [PMID: 31797470 DOI: 10.1111/den.13591] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 12/02/2019] [Indexed: 02/08/2023]
Abstract
Endoscopic submucosal dissection (ESD) is a rigorous and technically sophisticated method for removal of lesions within the gastrointestinal tract. Despite having advantages of en-bloc resection of lesions, regardless of size, and widespread use in Japan and Asia, ESD has not become widely adopted in the USA for a variety of reasons. Based upon Japanese education and the master-apprentice model, modification to the education system and additional techniques designed to facilitate broader adoption are required for trainees in the USA. This article will review the current state of education and training for ESD in the USA.
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Affiliation(s)
- Thomas R McCarty
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Hiroyuki Aihara
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
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18
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Zorron Cheng Tao Pu L, Yamamura T, Nakamura M, Esaki M, Kaosombatwattana U, Rodriguez MR, Edwards S, Burt AD, Singh R, Hirooka Y, Fujishiro M. Learning curve for mastery of colorectal endoscopic submucosal dissection: Perspectives from a large Japanese cohort. JGH Open 2020; 4:611-616. [PMID: 32782946 PMCID: PMC7411630 DOI: 10.1002/jgh3.12298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 01/03/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Leonardo Zorron Cheng Tao Pu
- Faculty of Health and Medical SciencesThe University of Adelaide Adelaide South Australia Australia
- Department of Gastroenterology and HepatologyNagoya University Nagoya Japan
| | | | - Masanao Nakamura
- Department of Gastroenterology and HepatologyNagoya University Nagoya Japan
| | - Masaya Esaki
- Department of EndoscopyNagoya University Hospital Nagoya Japan
| | | | - Miguel R Rodriguez
- Department of Gastroenterology and HepatologyNagoya University Nagoya Japan
| | - Suzanne Edwards
- Faculty of Health and Medical SciencesThe University of Adelaide Adelaide South Australia Australia
| | - Alastair D Burt
- Faculty of Health and Medical SciencesThe University of Adelaide Adelaide South Australia Australia
| | - Rajvinder Singh
- Faculty of Health and Medical SciencesThe University of Adelaide Adelaide South Australia Australia
- Department of GastroenterologyLyell McEwin Hospital Adelaide South Australia Australia
| | - Yoshiki Hirooka
- Department of Liver, Biliary Tract and Pancreas DiseasesFujita Health University Toyoake Japan
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19
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Endoscopic submucosal dissection for colorectal neoplasms in proximity or extending to a diverticulum. Surg Endosc 2020; 35:3479-3487. [PMID: 32671524 DOI: 10.1007/s00464-020-07795-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 07/07/2020] [Indexed: 12/14/2022]
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20
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Feasibility and learning curve of unsupervised colorectal endoscopic submucosal hydrodissection at a Western Center. Eur J Gastroenterol Hepatol 2020; 32:804-812. [PMID: 32175984 DOI: 10.1097/meg.0000000000001703] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Colorectal endoscopic submucosal dissection (CR-ESD) is an evolving technique in Western countries. We aimed to determine the results of the untutored implementation of endoscopic submucosal hydrodissection for the treatment of complex colorectal polyps and establish the learning curve for this technique. METHODS This study included data from 80 consecutive CR-ESDs performed by a single unsupervised western therapeutic endoscopist. To assess the learning curve, procedures were divided into four groups of 20 each. RESULTS En bloc resection was achieved in 55, 75, 75 and 95% cases in the consecutive time periods (period 1 vs. 4, P = 0.003). Curative resection was achieved in 55, 75, 70 and 95%, respectively (P = 0.037). Overall, series results demonstrated R0 resection in 75% of cases, with 23.7% requiring conversion to endoscopic piecemeal mucosal resection, and 1.25% incomplete resections. Complications included perforations (7.5%) and bleeding (3.7%). Multivariate analysis revealed factors more likely to result in association with non en bloc vs. En bloc resection, where polyp size ≥35 mm [70 vs. 23.4%; odds ratio (OR) 13.2 (1.7-100.9); P = 0. 013], severe fibrosis [40 vs. 11.7%; OR 10.2 (1.2-86.3); P = 0.033] and where carbon dioxide for insufflation was not used [65 vs. 30%; OR 0.09 (0.01-0.53); P = 0.008]. CONCLUSION CR-ESD by hydrodissection has good safety and efficacy profile and offers well tolerated and effective treatment for complex polyps. As such, this technique may be useful in the West, in centers, where previous gastric ESD is not frequent or Japanese mentoring is not possible.
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21
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Real-world learning curve analysis of colorectal endoscopic submucosal dissection: a large multicenter study. Surg Endosc 2019; 34:3344-3351. [DOI: 10.1007/s00464-019-07104-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 08/21/2019] [Indexed: 12/12/2022]
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Matsumoto S, Uehara T, Mashima H. Construction of a preoperative scoring system to predict the difficulty level of colorectal endoscopic submucosal dissection. PLoS One 2019; 14:e0219096. [PMID: 31247005 PMCID: PMC6597108 DOI: 10.1371/journal.pone.0219096] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 06/15/2019] [Indexed: 02/07/2023] Open
Abstract
Background We attempted to examine the factors contributing to the difficulty in performance of colorectal ESD, with the aim of constructing a scoring system that could help in prediction of the difficulty level of the procedure. Methods and materials The data were analyzed from two viewpoints: to determine the factors contributing to 1) non-en bloc resection and the factors contributing to 2) a slow resection speed. Factors falling under these two categories contributing to difficulty in performance of ESD were extracted and used to construct a scoring system. The validity of this scoring system was evaluated by calculating the correlation between the score and the resection speed in a different dataset. Results Based on the results of our analysis, we assigned scores for various factors as follows: 4 points for EMR of a scarred lesion, 1 point for tumors with a diameter of ≥ 30 mm, 2 points for lesions located in the liver/splenic flexure, 1 point for lesions located in the transverse colon, 3 points for LST-NG-PD/depressed lesions, 1 point for protruded lesions and LST-NG-F lesions (range 0–10). In the validation study, the rank correlation coefficient between the score according to the scoring system and the resection speed was -0.130, representing a weak and negative correlation (P = 0.03). We defined the difficulty level depending on the sum of the scores: 0–2, low difficulty level; 3–5, intermediate difficulty level; ≥ 6, high difficulty level. The average resection speed was 12.6 mm2/min in the group with scores of 0–2, 8.1 mm2/min in the group with scores of 3–5, and 5.5 mm2/min in the group with scores of ≥ 6 (11.2 mm2/min in all lesions). Conclusion Our colorectal ESD scoring system would be useful for selection of operators with the appropriate skill level in the procedure for colorectal ESD cases.
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Affiliation(s)
- Satohiro Matsumoto
- Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
- * E-mail:
| | - Takeshi Uehara
- Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Hirosato Mashima
- Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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23
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Ide D, Saito S, Ohya TR, Nishikawa Y, Horie Y, Yasue C, Chino A, Igarashi M, Saruta M, Fujisaki J. Colorectal endoscopic submucosal dissection can be efficiently performed by a trainee with use of a simple traction device and expert supervision. Endosc Int Open 2019; 7:E824-E832. [PMID: 31198847 PMCID: PMC6561769 DOI: 10.1055/a-0901-7113] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 02/26/2019] [Indexed: 02/07/2023] Open
Abstract
Background and study aims Colorectal endoscopic submucosal dissection (ESD) is technically challenging owing to submucosal fibrosis and difficult endoscope manipulation. Therefore, various traction methods have been reported. We often use a simple looped nylon thread attached to a clip to assist with dissection. We assessed the feasibility of mentor-guided colorectal ESD using this traction device (TD). Patients and methods From December 2017 to March 2018, we retrospectively reviewed outcomes of 101 colorectal ESDs performed by two groups of endoscopists (A, 5 endoscopists with colorectal ESD experience of < 50 cases; B, 5 endoscopists with experience of > 300 cases). Group A was further divided into two subgroups that performed ESD with or without TD. Results No significant difference was observed in ESD completion rates (86.1 % [62/72] vs. 96.6 % [28/29]; odds ratio [OR], 0.22; 95 % confidence interval [CI], 0.005 - 1.71; P = 0.17) or procedure times (52.0 min vs. 40.0 min; P = 0.27) and adverse event rates between groups A and B. The rate of TD use was significantly higher in group A than in group B (44.4 % [32/72] vs. 20.7 % [6/29]; OR, 3.03; CI, 1.04 - 10.23; P = 0.03). The completion rate was not different between the two subgroups of group A (with vs. without TD) (81.2 % [26/32] vs. 90.0 % [36/40]; OR, 0.49; CI, 0.09 - 2.29; P = 0.32); however, the proportion of fibrosis cases was significantly higher in the TD-use group (46.8 % [15/32] vs. 22.5 % [9/40]; OR, 2.99; CI, 0.98 - 9.59; P = 0.03). Conclusion Mentor-guided colorectal ESD using TD was performed efficiently, safely, and in a manner comparable to that of experts.
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Affiliation(s)
- Daisuke Ide
- Department of Lower Gastrointestinal Medicine, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan,Department of Internal Medicine, Division of Gastroenterology and Hepatology, The Jikei University School of Medicine, Tokyo, Japan,Corresponding author Daisuke Ide, MD, PhD Department of Lower Gastrointestinal MedicineThe Cancer Institute Hospital of Japanese Foundation for Cancer Research3-8-31, Ariake, KotoTokyo 135-8550Japan+81-3-3520-0141
| | - Shoichi Saito
- Department of Lower Gastrointestinal Medicine, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | | | - Yuske Nishikawa
- Department of Lower Gastrointestinal Medicine, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yoshimasa Horie
- Department of Lower Gastrointestinal Medicine, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Chihiro Yasue
- Department of Lower Gastrointestinal Medicine, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Akiko Chino
- Department of Lower Gastrointestinal Medicine, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Masahiro Igarashi
- Department of Lower Gastrointestinal Medicine, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Masayuki Saruta
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, The Jikei University School of Medicine, Tokyo, Japan
| | - Junko Fujisaki
- Department of Upper Gastrointestinal Medicine, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
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Yamamoto S, Radomski T, Shafazand M. Implementation of mentor-assisted colorectal endoscopic submucosal dissection in Sweden; learning curve and clinical outcomes. Scand J Gastroenterol 2018; 53:1146-1152. [PMID: 30270682 DOI: 10.1080/00365521.2018.1498912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE It's still challenging to introduce colorectal (CR) ESD in Western countries. We assessed the feasibility of introducing and implementing CR-ESD in Sweden with hiring Japanese expert as a supervisor. METHODS We analyzed 71 consecutive CR-ESD cases performed by two endoscopists who had no (endoscopist A (E-A)) or 20 cases (endoscopist B (E-B)) of experience in ESD. E-A performed rectal lesions while E-B performed lesions in any locations. Factors associated with failure in en bloc resection and in self-accomplishment were analyzed. RESULTS Overall en bloc and R0 resection rates were 80.3% and 70.4%. Adverse event occurred in 7.0% including two perforations, two post-operative hemorrhage and one delayed perforation. Only case with delayed perforation underwent surgical treatment. Total self-accomplishment rate was 50% (10/20) for E-A, and 37.3% (19/51) for E-B. Dividing each performer's cases into three learning phases, self-accomplishment rates increased from 42.9% to 83.3% for E-A, and from 29.4% to 70.6% for E-B, as well as en bloc resection rates from 71.4% to 100% for E-A, and from 52.9% to 94.1% for E-B. Multivariate analysis revealed that location upper than rectum, lesions with formerly taken biopsy and lesions larger than 30mm were significantly associated with en bloc resection failure. CONCLUSIONS Implementation of CR-ESD with hiring Japanese supervisor for certain period was safe for patients and effective for good learning curve.
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Affiliation(s)
- Shunsuke Yamamoto
- a Department of Gastroenterology , Sahlgrenska University Hospital , Östra , Sweden
| | - Tomasz Radomski
- a Department of Gastroenterology , Sahlgrenska University Hospital , Östra , Sweden
| | - Morteza Shafazand
- a Department of Gastroenterology , Sahlgrenska University Hospital , Östra , Sweden
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Kuwai T, Yamaguchi T, Imagawa H, Miura R, Sumida Y, Takasago T, Miyasako Y, Nishimura T, Iio S, Yamaguchi A, Kouno H, Kohno H, Ishaq S. Endoscopic submucosal dissection for early esophageal neoplasms using the stag beetle knife. World J Gastroenterol 2018; 24:1632-1640. [PMID: 29686470 PMCID: PMC5910546 DOI: 10.3748/wjg.v24.i15.1632] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 03/16/2018] [Accepted: 03/30/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To determine short- and long-term outcomes of endoscopic submucosal dissection (ESD) using the stag beetle (SB) knife, a scissor-shaped device.
METHODS Seventy consecutive patients with 96 early esophageal neoplasms, who underwent ESD using a SB knife at Kure Medical Center and Chugoku Cancer Center, Japan, between April 2010 and August 2016, were retrospectively evaluated. Clinicopathological characteristics of lesions and procedural adverse events were assessed. Therapeutic success was evaluated on the basis of en bloc, histologically complete, and curative or non-curative resection rates. Overall and tumor-specific survival, local or distant recurrence, and 3- and 5-year cumulative overall metachronous cancer rates were also assessed.
RESULTS Eligible patients had dysplasia/intraepithelial neoplasia (22%) or early cancers (squamous cell carcinoma, 78%). The median procedural time was 60 min and on average, the lesions measured 24 mm in diameter, yielding 33-mm tissue defects. The en bloc resection rate was 100%, with 95% and 81% of dissections deemed histologically complete and curative, respectively. All procedures were completed without accidental incisions/perforations or delayed bleeding. During follow-up (mean, 35 ± 23 mo), no local recurrences or metastases were observed. The 3- and 5-year survival rates were 83% and 70%, respectively, with corresponding rates of 85% and 75% for curative resections and 74% and 49% for non-curative resections. The 3- and 5-year cumulative rates of metachronous cancer in the patients with curative resections were 14% and 26%, respectively.
CONCLUSION ESD procedures using the SB knife are feasible, safe, and effective for treating early esophageal neoplasms, yielding favorable short- and long-term outcomes.
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Affiliation(s)
- Toshio Kuwai
- Department of Gastroenterology, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Kure 737-0023, Japan
| | - Toshiki Yamaguchi
- Department of Gastroenterology, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Kure 737-0023, Japan
| | - Hiroki Imagawa
- Department of Gastroenterology, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Kure 737-0023, Japan
| | - Ryoichi Miura
- Department of Gastroenterology, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Kure 737-0023, Japan
| | - Yuki Sumida
- Department of Gastroenterology, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Kure 737-0023, Japan
| | - Takeshi Takasago
- Department of Gastroenterology, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Kure 737-0023, Japan
| | - Yuki Miyasako
- Department of Gastroenterology, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Kure 737-0023, Japan
| | - Tomoyuki Nishimura
- Department of Gastroenterology, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Kure 737-0023, Japan
| | - Sumio Iio
- Department of Gastroenterology, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Kure 737-0023, Japan
| | - Atsushi Yamaguchi
- Department of Gastroenterology, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Kure 737-0023, Japan
| | - Hirotaka Kouno
- Department of Gastroenterology, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Kure 737-0023, Japan
| | - Hiroshi Kohno
- Department of Gastroenterology, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Kure 737-0023, Japan
| | - Sauid Ishaq
- Department of Gastroenterology, DGH, SGU, WI, Birmingham City University, Birmingham B4 7BD, United Kingdom
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Arimoto J, Higurashi T, Kato S, Fuyuki A, Ohkubo H, Nonaka T, Yamaguchi Y, Ashikari K, Chiba H, Goto S, Taguri M, Sakaguchi T, Atsukawa K, Nakajima A. Risk factors for post-colorectal endoscopic submucosal dissection (ESD) coagulation syndrome: a multicenter, prospective, observational study. Endosc Int Open 2018; 6. [PMID: 29527556 PMCID: PMC5842075 DOI: 10.1055/s-0044-101451] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Colorectal cancer (CRC) is one of the most common neoplasms and endoscopic submucosal dissection (ESD) is an effective treatment for early-stage CRC. However, it has been observed that patients undergoing ESD often complain of pain, even if ESD has been successfully performed. Risk factors for such pain still remain unknown. The aim of this study was to explore the risk factors for post-colorectal ESD coagulation syndrome (PECS). PATIENTS AND METHODS This was a prospective multicenter observational trial (UMIN000016781) conducted in 106 of 223 patients who underwent ESD between March 2015 and April 2016. We investigated age, sex, tumor location, ESD operation time, lesion size, duration of hospitalization, and frequency of PECS. We defined PECS as local abdominal pain (evaluated on a visual analogue scale) in the region corresponding to the site of the ESD that occurred within 4 days of the procedure. RESULTS PECS occurred in 15/106 (14.2 %), and 10 were women ( P = 0.01, OR: 7.74 [1.6 - 36.4]), 7 had lesions in the cecum ( P < 0.001, OR: 20.6 [3.7 - 115.2]), and 9 in whom ESD operation time was > 90 min ( P = 0.002, OR: 10.3 [2.4 - 44.6]). Frequency of deviation from the prescribed clinical path was significantly higher (47 % [7/15] vs. 2 % [2/91], P < 0.001, OR: 38.9 [6.9 - 219.6]), and hospital stay was significantly longer in the PECS group. . CONCLUSIONS Female gender, location of lesion in the cecum, and ESD operation time > 90 minutes were significant risk factors independent of PECS. These findings are important to management of PECS. .
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Affiliation(s)
- Jun Arimoto
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Takuma Higurashi
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Shingo Kato
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Akiko Fuyuki
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Hidenori Ohkubo
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Takashi Nonaka
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Yoshikazu Yamaguchi
- Department of Anesthesiology and Critical Care, Yokohama City University School of Medicine, Yokohama, Japan
| | - Keiichi Ashikari
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
| | - Hideyuki Chiba
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
| | - Shungo Goto
- Department of Gastroenterology, Hiratsuka City Hospital, Hiratsuka, Japan
| | - Masataka Taguri
- Department of Biostatistics, Yokohama City University School of Medicine, Yokohama, Japan
| | - Takashi Sakaguchi
- Department of Gastroenterology, Hiratsuka City Hospital, Hiratsuka, Japan
| | - Kazuhiro Atsukawa
- Department of Gastroenterology, Hiratsuka City Hospital, Hiratsuka, Japan
| | - Atsushi Nakajima
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan,Corresponding author Atsushi Nakajima 3-9 Fukuura, Kanazawa-kuYokohama 236-0004Japan+81-45-784-3546
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Ohata K, Muramoto T, Minato Y, Chiba H, Sakai E, Matsuhashi N. Usefulness of a multifunctional snare designed for colorectal hybrid endoscopic submucosal dissection (with video). Endosc Int Open 2018; 6:E249-E253. [PMID: 29423435 PMCID: PMC5803000 DOI: 10.1055/s-0043-124364] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 11/14/2017] [Indexed: 12/11/2022] Open
Abstract
UNLABELLED Since colorectal endoscopic submucosal dissection (ESD) remains technically difficult, hybrid ESD was developed as an alternative therapeutic option to achieve en bloc resection of relatively large lesions. In this feasibility study, we evaluated the safety and efficacy of hybrid colorectal ESD using a newly developed multifunctional snare. From June to August 2016, we prospectively enrolled 10 consecutive patients with non-pedunculated intramucosal colorectal tumors 20 - 30 mm in diameter. All of the hybrid ESD steps were performed using the "SOUTEN" snare. The knob-shaped tip attached to the loop top helps to stabilize the needle-knife, making it less likely to slip during circumferential incision and enables partial submucosal dissection. All of the lesions were curatively resected by hybrid ESD, with a short mean procedure time (16.1 ± 4.8 minutes). The mean diameters of the resected specimens and tumors were 30.5 ± 4.9 and 26.0 ± 3.5 mm, respectively. No perforations occurred, while delayed bleeding occurred in 1 patient. In conclusion, hybrid ESD using a multifunctional snare enables easy, safe, and cost-effective resection of relatively large colorectal tumors to be achieved. STUDY REGISTRATION UMIN000022545.
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Affiliation(s)
- Ken Ohata
- Department of Gastroenterology, NTT Medical Center Tokyo, Tokyo, Japan,Corresponding author Ken Ohata, MD Division of GastroenterologyNTT Medical Center Tokyo5-9-22 Higashi-GotandaShinagawa-kuTokyo141-8625Japan+81-3-34486541
| | - Takashi Muramoto
- Department of Gastroenterology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Yohei Minato
- Department of Gastroenterology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Hideyuki Chiba
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
| | - Eiji Sakai
- Department of Gastroenterology, NTT Medical Center Tokyo, Tokyo, Japan
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Spychalski M, Skulimowski A, Dziki A, Saito Y. Colorectal endoscopic submucosal dissection (ESD) in the West - when can satisfactory results be obtained? A single-operator learning curve analysis. Scand J Gastroenterol 2017; 52:1442-1452. [PMID: 28942690 DOI: 10.1080/00365521.2017.1379557] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Up to date we lack a detailed description of the colorectal endoscopic submucosal dissection (ESD) learning curve, that would represent the experience of the Western center. The aim of this study was to define the critical points of the learning curve and to draw up lesions qualification guidelines tailored to the endoscopists experience. MATERIALS AND METHODS We have carried out a single center prospective study. Between June 2013 and December 2016, 228 primary colorectal lesions were managed by ESD procedure. In order to create a learning curve model and to carry out the analysis the cases were divided into six periods, each consisting of 38 cases. RESULTS The overall en bloc resection rate was 79.39%. The lowest en bloc resection rate (52.36%) was observed in the first period. After completing 76 procedures, the resection rate surged to 86% and it was accompanied by the significant increase in the mean procedure speed of ≥9 cm2/h. Lesions localization and diameter had a signification impact on the outcomes. After 76 procedures, en bloc resection rate of 90.9 and 90.67% were achieved for the left side of colon and rectum, respectively. In the right side of colon statistically significant lower resection rate of 67.57% was observed. CONCLUSION We have proved that in the setting of the Western center, colorectal ESD can yield excellent results. It seems that the key to the success during the learning period is 'tailoring' lesions qualification guidelines to the experience of the endoscopist, as lesions diameter and localization highly influence the outcomes.
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Affiliation(s)
- Michał Spychalski
- a Department of General and Colorectal Surgery , Medical University of Lodz , Lodz , Poland
| | - Aleksander Skulimowski
- b Department of General Surgery , Multidisciplinary Hospital Brzeziny , Brzeziny , Poland
| | - Adam Dziki
- a Department of General and Colorectal Surgery , Medical University of Lodz , Lodz , Poland
| | - Yutaka Saito
- c Gastrointestinal Endoscopy Division , National Cancer Center Hospital , Tokyo , Japan
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Wang AY, Draganov PV. Training in endoscopic submucosal dissection from a Western perspective. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2017. [DOI: 10.1016/j.tgie.2017.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Chiba H, Tachikawa J, Kurihara D, Ashikari K, Goto T, Takahashi A, Sakai E, Ohata K, Nakajima A. Safety and efficacy of simultaneous colorectal ESD for large synchronous colorectal lesions. Endosc Int Open 2017; 5:E595-E602. [PMID: 28670616 PMCID: PMC5482740 DOI: 10.1055/s-0043-110567] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 03/20/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Multiple large colorectal lesions are sometimes diagnosed during colonoscopy. However, there have been no investigations of the feasibility of simultaneous endoscopic submucosal dissection (ESD) for multiple lesions. This study aims to reveal the strategy of simultaneous ESD for multiple large colorectal lesions. PATIENTS AND METHODS 246 patients who underwent ESD for 274 colorectal lesions were retrospectively evaluated in this study. Fifty-one large colorectal lesions among 23 patients were treated by ESD simultaneously (simultaneous group), and 223 patients were treated with ESD for a single lesion (single group). RESULTS En-bloc resection and curative resection rates did not differ. Compared with the single group, each procedure time was faster (31.8 ± 23.6 min vs. 45.8 ± 44.8, P = 0.002), but total procedure time was significantly longer in the simultaneous group (70.6 ± 33.4 vs. 45.8 ± 44.8 min, P = 0.01). Rates of adverse events including bleeding and perforation were not higher in the simultaneous group but the mean blood pressure, incidence of bradycardia and the amount of sedative drug used during ESD were significantly higher in the simultaneous group. Multiple logistic regression analysis identified non-experienced physician, lesion size ≥ 40 mm and submucosal fibrosis as an independent risk factor for procedure duration (≥ 90 min) (Odds ratio 11.852, 18.280, and 3.672; P < 0.05, respectively). CONCLUSIONS Simultaneous ESD for multiple synchronous colorectal lesions is safe and feasible compared with single ESD and can reduce the burden to patients, length of hospital stay and medical expense. These results need to be elucidated by further studies.
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Affiliation(s)
- Hideyuki Chiba
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan,Corresponding author Hideyuki Chiba MD, PhD Department of Gastroenterology, Omori Red Cross Hospital4-30-1 Chuo, Ota-KuTokyo, 143-8527Japan
| | - Jun Tachikawa
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
| | - Daisuke Kurihara
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
| | - Keiichi Ashikari
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
| | - Toru Goto
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
| | - Akihiro Takahashi
- Department of Gastroenterology, Nerima Hikarigaoka Hospital, Tokyo, Japan
| | - Eiji Sakai
- Department of Gastroenterology, Tokyo, Japan
| | - Ken Ohata
- Department of Gastroenterology, Tokyo, Japan
| | - Atsushi Nakajima
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
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Kasapidis P, Bassioukas S, Mavrogenis G, Tribonias G, Delis K, Georgopoulos S, Christodoulou D, Emmanouil T, Paraskeva K, Panteris V, Papalois A, Triantafillidis J, Tsiamoulos Z, Fukuhara T, Komeda Y, Kashida H. Experimental gastric endoscopic submucosal dissection: training in a porcine model. Ann Gastroenterol 2017; 30:446-449. [PMID: 28655983 PMCID: PMC5479999 DOI: 10.20524/aog.2017.0147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 03/05/2017] [Indexed: 12/18/2022] Open
Abstract
Background Endoscopic submucosal dissection (ESD) requires special skills and a long procedure time for a quality-controlled procedure. A universal training system remains to be established. Hands-on courses in animal models before advancing to the human colon appear to be essential, especially in Europe. The learning curve is a prerequisite in ESD, in order to improve technical outcomes and decrease the rate of procedural adverse events. Methods In the experimental research center of ELPEN Pharmaceuticals, 18 European endoscopists, inexperienced at ESD, performed gastric ESDs in porcine models. The course lasted two days and was conducted under the supervision of experts. Results A total of 72 of 76 ESDs were completed en bloc (94.7%). The procedural time and cutting speed differed significantly between the first and second day: 48±4.4 vs. 43±4.8 min (P=0.0045), and 1.38±0.20 vs. 1.63±0.23 cm2/min (P=0.0033), respectively. The complications were not significantly different between the two groups: five (13.88%) vs. four (11%) episodes of bleeding (P>0.05). The perforation rate was similar, at two episodes per day (5.55%). We documented an acceptable rate of en bloc resections and complications. Conclusion ESD demands a new level of endoscopic skills in Europe. A formal sequential training program, using porcine models, may benefit countries with a low volume of cases.
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Affiliation(s)
- Panagiotis Kasapidis
- Head, Department of Gastroenterology and Endoscopy Unit, Central Clinic, Athens, Greece (Panagiotis Kasapidis)
| | | | - Georgios Mavrogenis
- Department of Endoscopy, Mediterraneo Hospital, Athens, Greece (Georgios Mavrogenis)
| | - Georgios Tribonias
- Department of Endoscopy, Eugenideio Hospital, Athens, Greece (Georgios Tribonias)
| | - Konstantinos Delis
- Department of Gastroenterology, Metropolitan Hospital, Piraeus, Greece (Konstantinos Delis)
| | - Sotirios Georgopoulos
- Department of Gastroenterology and Endoscopy Unit, Athens Medical Center, Faliron, Athens, Greece (Sotirios Georgopoulos)
| | - Dimitrios Christodoulou
- Gastroenterology Department, University of Ioannina, School of Medicine, Ioannina, Greece (Dimitrios Christodoulou)
| | | | - Konstantina Paraskeva
- Department of Gastroenterology, Konstantopoulion General Hospital, Athens, Greece (Konstantina Paraskeva)
| | | | | | | | - Zacharias Tsiamoulos
- GI Endoscopy East Kent University Hospitals Trust Senior Clinical Researcher, Imperial College, London St Mark's Hospital/Academic Institute, United Kingdom (Zacharias Tsiamoulos)
| | - Takataro Fukuhara
- Department of Molecular Genetics, Institute for Biomedical Science, Division of Gastroenterology and Hepatology, The Third Department of Internal Medicine, Kansai Medical University, Hirakata, Osaka, Japan (Takataro Fukuhara)
| | - Yoriaki Komeda
- Department of Gastroenterology and Hepatology, Ohno-Higashi, Osaka-Sayama, Osaka, Japan, Faculty of Medicine, Kindai University (Yoriaki Komeda, Hiroshi Kashida)
| | - Hiroshi Kashida
- Department of Gastroenterology and Hepatology, Ohno-Higashi, Osaka-Sayama, Osaka, Japan, Faculty of Medicine, Kindai University (Yoriaki Komeda, Hiroshi Kashida)
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Sato H, Mizuno KI, Sato Y, Hashimoto S, Hayashi K, Ikarashi S, Honda Y, Yokoyama J, Terai S. Development and use of a non-biomaterial model for hands-on training of endoscopic procedures. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:182. [PMID: 28616397 DOI: 10.21037/atm.2017.01.27] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) and peroral endoscopic myotomy (POEM) are recently developed techniques that have the potential to significantly improve clinical outcomes. However, training opportunities on these techniques remain limited. To address this issue, we developed a novel ex-vivo ESD/POEM training model. Our aim in this paper is to describe the model and provide preliminary evidence of promising feasibility to improve access to ESD/POEM training. METHODS The model was developed using polyvinyl alcohol hydrogel, which can easily be modified to reproduce the stiffness of the different intestinal layers, namely the mucosa, submucosa, and muscle layer. RESULTS A training workshop, using our ex-vivo model, was held for 28 residents. Satisfaction and feasibility in using the ex-vivo model for endoscopic training were evaluated by using a self-report questionnaire. All participants were satisfied with their training experience (100% satisfaction rate), with 27 of the 28 participants reporting that the model was feasible in replicating all components of the ESD/POEM technique (96.4% feasibility rate). CONCLUSIONS Based on this feedback, we propose that our non-biomaterial model has the feasibility to provide an effective endoscopy education tool and a satisfactory training experience.
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Affiliation(s)
- Hiroki Sato
- Division of Gastroenterology and Hepatology, Niigata University Medical and Dental Hospital, Niigata, Japan.,Division of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital, Niigata, Japan
| | - Ken-Ichi Mizuno
- Division of Gastroenterology and Hepatology, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Yuichi Sato
- Division of Gastroenterology and Hepatology, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Satoru Hashimoto
- Division of Gastroenterology and Hepatology, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Kazunao Hayashi
- Division of Gastroenterology and Hepatology, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Satoshi Ikarashi
- Division of Gastroenterology and Hepatology, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Yutaka Honda
- Division of Gastroenterology and Hepatology, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Junji Yokoyama
- Division of Gastroenterology and Hepatology, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Shuji Terai
- Division of Gastroenterology and Hepatology, Niigata University Medical and Dental Hospital, Niigata, Japan
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Shiga H, Ohba R, Matsuhashi T, Jin M, Kuroha M, Endo K, Moroi R, Kayaba S, Iijima K. Feasibility of colorectal endoscopic submucosal dissection (ESD) carried out by endoscopists with no or little experience in gastric ESD. Dig Endosc 2017; 29 Suppl 2:58-65. [PMID: 28425662 DOI: 10.1111/den.12814] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 01/16/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIM Colorectal endoscopic submucosal dissection (ESD) is recommended to be carried out only by endoscopists with sufficient experience in gastric ESD. However, early gastric carcinoma is less common in Western countries than in Japan, and endoscopic maneuverability differs between the stomach and colorectum. We assessed the feasibility of colorectal ESD carried out by endoscopists with no or little experience in gastric ESD. METHODS We analyzed en bloc resection, R0 resection and perforation rates in 180 consecutive colorectal ESD carried out by three endoscopists who had no or <5 cases of experience in gastric ESD. We also identified factors associated with R0 resection failure. RESULTS Overall en bloc and R0 resection rates were 93.3% (168/180) and 82.2% (148/180), respectively. All 11 cases with perforation were treated endoscopically. Dividing 180 cases into three learning phases (early, middle, or late phases), the en bloc and R0 resection rates increased from 88.3% and 75.0% in the early phase to 98.3% and 88.3% in the late phase, respectively. Perforation rate also improved from 10.0% to 3.3%. Factors associated with R0 resection failure were location at junctions (odds ratio: 6.8, 95% CI: 1.9-27.5), preoperative factors reflecting fibrosis (5.8, 1.9-19.0), and late phase (0.2, 0.1-0.7). CONCLUSION Endoscopists without experience in gastric ESD carried out colorectal ESD safely. In the early and middle phases (≤40 cases), they should treat mainly rectal lesions but may also resect lesions in the colon avoiding flexures. Lesions located at junctions and those with preoperative factors reflecting fibrosis should be resected after completing 40 procedures.
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Affiliation(s)
- Hisashi Shiga
- Department of Gastroenterology and Neurology, Akita University Graduate School of Medicine, Akita, Japan
| | - Reina Ohba
- Department of Gastroenterology and Neurology, Akita University Graduate School of Medicine, Akita, Japan
| | - Tamotsu Matsuhashi
- Department of Gastroenterology and Neurology, Akita University Graduate School of Medicine, Akita, Japan
| | - Mario Jin
- Department of Gastroenterology and Neurology, Akita University Graduate School of Medicine, Akita, Japan
| | - Masatake Kuroha
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Katsuya Endo
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Rintaro Moroi
- Department of Gastroenterology, Iwate Prefectural Isawa Hospital, Oshu, Japan
| | - Shoichi Kayaba
- Department of Gastroenterology, Iwate Prefectural Isawa Hospital, Oshu, Japan
| | - Katsunori Iijima
- Department of Gastroenterology and Neurology, Akita University Graduate School of Medicine, Akita, Japan
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Oka S, Uraoka T, Tamai N, Ikematsu H, Chino A, Okamoto K, Takeuchi Y, Imai K, Ohata K, Shiga H, Raftopoulos S, Lee BI, Matsuda T. Standardization of endoscopic resection for colorectal tumors larger than 10 mm in diameter. Dig Endosc 2017; 29 Suppl 2:40-44. [PMID: 28425665 DOI: 10.1111/den.12829] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 01/30/2017] [Indexed: 01/13/2023]
Abstract
Currently, several endoscopic resection (ER) methods for colorectal tumors are available, including polypectomy, conventional endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), and modified ER. In the present review, we mainly focus on the current status of ER for colorectal tumors as well as the report from the Endoscopic Forum Japan (EFJ) 2016, which was held in Tokyo in August 2016. The proposed ER methods for colorectal tumors larger than 10 mm in diameter are as follows. (i) Pedunculated-type tumor is an indication for polypectomy, regardless of size. (ii) Non-pedunculated-type tumor larger than 20 mm in diameter is an indication for ESD in which en bloc resection using conventional EMR is difficult or impossible. (iii) Non-pedunculated-type tumor from 10 mm to 20 mm in diameter is an indication for conventional EMR. However, ESD or modified ER methods are acceptable according to the procedure and the condition of the tumor.
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Affiliation(s)
- Shiro Oka
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Toshio Uraoka
- Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Naoto Tamai
- Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiroaki Ikematsu
- Department of Gastrointestinal Oncology & Endoscopy, National Cancer Center Hospital East, Kashiwa, Japan
| | - Akiko Chino
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Koichi Okamoto
- Department of Gastroenterology and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Yoji Takeuchi
- Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Kenichiro Imai
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Ken Ohata
- Department of Gastroenterology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Hisashi Shiga
- Department of Gastroenterology, Akita University Graduate School of Medicine, Akita, Japan
| | - Spiro Raftopoulos
- Department of Gastroenterology and Hepatology, Sir Charles Gairdner Hospital, Perth, Australia
| | - Bo-In Lee
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Takahisa Matsuda
- Cancer Screening Center, National Cancer Center Hospital, Tokyo, Japan
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35
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Longcroft-Wheaton G, Bhandari P. Management of early colonic neoplasia: where are we now and where are we heading? Expert Rev Gastroenterol Hepatol 2017; 11:227-236. [PMID: 28052695 DOI: 10.1080/17474124.2017.1279051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
There have been considerable advances in the endoscopic treatment of colorectal neoplasia. The development of endoscopic submucosal dissection and full thickness resection techniques is changing the way benign disease and early cancers are managed. This article reviews the evidence behind these new techniques and discusses where this field is likely to move in the future. Areas covered: A PubMed literature review of resection techniques for colonic neoplasia was performed. The clinical and cost effectiveness of endoscopic mucosal resection (EMR) is examined. The development of endoscopic submucosal dissection (ESD) and knife assisted resection is described and issues around training reviewed. Efficacy is compared to both EMR and transanal endoscopic microsurgery. The future is considered, including full thickness resection techniques and robotic endoscopy. Expert commentary: The perceived barriers to ESD are falling, and views that such techniques are only possible in Japan are disappearing. The key barriers to uptake will be training, and the development of educational programmes should be seen as a priority. The debate between TEMS and ESD will continue, but ESD is more flexible and cheaper. This will become less significant as the number of endoscopists trained in ESD grows and some TEMS surgeons may shift across towards ESD.
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Affiliation(s)
- Gaius Longcroft-Wheaton
- a Department of Endoscopy , Queen Alexandra Hospital , Portsmouth , UK.,b Department of Pharmacy and Biomedical sciences , University of Portsmouth , Portsmouth , United Kingdom
| | - Pradeep Bhandari
- a Department of Endoscopy , Queen Alexandra Hospital , Portsmouth , UK.,b Department of Pharmacy and Biomedical sciences , University of Portsmouth , Portsmouth , United Kingdom
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