Single-Operator Learning Curve For Endoscopic Submucosal Dissection With An Untutored, Prevalence-Based Approach In A Non-Academic Greek Hospital

Aims The aim of this report is to present a real-life experience of practicing ESD without tutoring in a private medium sized non-academic hospital in Greece by a junior endoscopist who was trained exclusively in Europe.

Methods 60 ESD cases were performed in 57 patients (31 males) with a mean age of 65 years (36-86) for lesions of the esophagus (3), stomach (24), duodenum (1), colon (12) and rectum (20). 20 lesions were subepithelial. Propofol sedation was given in 16 rectal cases and general anesthesia in the rest. All procedures were performed by a single junior endoscopist without tutoring, after an observation period of 1 year in an academic hospital and performance of 20 animal cases.

Results Histology showed G1 NET (7), other submucosal tumors (13), gastric cancer or high-grade dysplasia (5), gastric low-grade dysplasia/hyperplastic polyp (5), colorectal cancer or high-grade dysplasia (8), colorectal low-grade dysplasia (21), early esophageal neoplasia (1). The mean diameter of the specimens was 3.7 cm (0.7-9,8). The mean duration was 2,2 hours (0.20-10).En block resection was achieved in 58/60 (96 %) lesions and R0 resection in 54/60 cases (90 %). Postoperative bleeding occurred in 3 cases (5 %) and was managed endoscopically. Perforation occurred in 5 cases (8 %). However, only two cases needed surgery with laparoscopic drainage. The mean hospitalisation lasted 1,3 days (0-3). The mean dissection speed was steady at 3,36 cm²/h for the first 20 cases and then it was progressively improved, reaching 11,4 cm²/h after 32 cases and then 14.5 cm²/h in the last five cases.

Conclusions ESD was safely and effectively performed by a junior ESD endoscopist without mentoring in a private non-academic hospital. At least 20 cases of ESD were needed to notice a steady improvement in the dissection speed and at least 30 cases to reach a satisfactory speed of > 9 cm²/h.

Citation Mavrogenis G, Bazerbachi F, Tsevgas I et al. eP118 SINGLE-OPERATOR LEARNING CURVE FOR ENDOSCOPIC SUBMUCOSAL DISSECTION WITH AN UNTUTORED, PREVALENCE-BASED APPROACH IN A NON-ACADEMIC GREEK HOSPITAL. Endoscopy 2021; 53: S134.

Publication History

Article published online:
19 March 2021