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THE LEARNING CURVE FOR ENDOSCOPIC SUBMUCOSAL DISSECTION IN EARLY GASTRIC NEOPLASM: SINGLE OPERATOR OVER 800 CASES EXPERIENCE IN EIGHT YEARS

Choong-Kyun Noh 1, Gil Ho Lee 1, Kee Myung Lee 1

Affiliations

1 Ajou University School of Medicine, Suwon, Korea, Republic of

Summary

AI Generated

A single-operator learning curve analysis of 811 consecutive gastric endoscopic submucosal dissections found that 156 cases were required to achieve proficiency using a redefined speed benchmark of 16.5 cm²/h.

Overall en-bloc resection was 98.6%, R0 resection 96.3%, and curability 93.7% across 811 gastric ESDs performed between March 2016 and December 2022
Median ESD speed was 18.1 cm²/h overall, with slower speeds in the upper third (9.9 cm²/h), with submucosal fibrosis (11.0 cm²/h), and with subcutaneous fat (11.1 cm²/h)
Traditional proficiency benchmarks (en-bloc resection >90%, R0 resection >80%, speed >9 cm²/h) were met from the first case
Using CUSUM analysis, the study established a new speed benchmark of 16.5 cm²/h and identified 156 cases as the threshold for achieving proficiency
The authors conclude that improved endoscopic equipment necessitates higher proficiency benchmarks for gastric ESD

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

Endoscopic submucosal dissection (ESD) is recommended as a treatment modality for early gastric cancer because it allows organ-sparing, curative en-bloc resection, and complete histopathological evaluation. Although many endoscopists are interested in learning how to perform ESD, the procedure requires a high level of expertise and is technically challenging, especially for less experienced endoscopists.

Aims & Methods

This study aimed to investigate the single-operator learning curve and clinical outcomes of consecutive gastric ESDs. Eight hundred-eleven gastric ESDs were performed between March 2016 and December 2022. The learning curve for ESD was evaluated using the cumulative sum (CUSUM) method to analyze the number of ESDs required for achieving proficiency.

Results

Of the enrolled patients, 310 (40.9%) cases were diagnosed with early gastric cancer. Overall en-bloc resection rates, R0 resection, and curability is 98.6%, 96.3%, and 93.7%, respectively. The median ESD speed was 18.1 cm2/h (IQR 12.2 – 25.3). ESD speed was slower than average in the upper third (9.9 cm2/h), presence of submucosal fibrosis (11.0 cm2/h) and the presence of subcutaneous fat (11.1 cm2/h), and faster than 20 cm2/h in the lower third (20.2 cm2/h) and lesion sized > 3 cm (23.6 cm2/h). According to the existing literature, the proficiency benchmark is defined as en-bloc resection >90%, R0 resection and >80%, and resection speed >9 cm2/h. However, since the first case satisfies all the existing benchmarks, we should establish a new definition of speed among benchmarks. In the changes of resection speed, we defined 16.5 cm2/h as a benchmark for ESD speed, which is the median value of the rapidly changing slope, and the CUSUM curve revealed that 156 cases were needed to achieve proficiency.

Conclusion

Due to the development of endoscopic equipment, a higher level of ESD proficiency benchmark is required. One hundred sixty-five cases were required to attain a higher technical level of successful performance in gastric ESD.

Conference

UEG Week Copenhagen 2023

Topics

Oesophagus

Submission format

Abstract

Session

PP 01 Oesophageal, gastric and duodenal disorders (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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