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Endoscopy 2023; 55(12): 1095-1102
DOI: 10.1055/a-2121-1148
Original article

A novel tool for case selection in endoscopic mucosal resection training

Timothy O’Sullivan
1   Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia
2   Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
,
Mayenaaz Sidhu
1   Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia
2   Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
,
Sunil Gupta 
1   Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia
2   Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
,
Karen Byth
3   Research and Education Network, Western Sydney Local Health District, Westmead Hospital, Sydney, New South Wales, Australia
4   The NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
,
James Elhindi
3   Research and Education Network, Western Sydney Local Health District, Westmead Hospital, Sydney, New South Wales, Australia
5   Reproduction and Perinatal Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
,
David Tate
1   Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia
6   University of Ghent, Ghent, Belgium
7   Department of Gastroenterology and Hepatology, University Hospital of Ghent, Ghent, Belgium
,
Oliver Cronin
1   Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia
2   Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
,
Anthony Whitfield
1   Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia
2   Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
,
Hunter Wang
1   Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia
2   Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
,
Eric Lee
1   Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia
,
Stephen Williams
1   Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia
,
Nicholas G. Burgess 
1   Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia
2   Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
,
Michael J. Bourke
1   Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia
2   Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
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Abstract

Background As endoscopic mucosal resection (EMR) of large (≥ 20 mm) adenomatous nonpedunculated colonic polyps (LNPCPs) becomes widely practiced outside expert centers, appropriate training is necessary to avoid failed resection and inappropriate surgical referral. No EMR-specific tool guides case selection for endoscopists learning EMR. This study aimed to develop an EMR case selection score (EMR-CSS) to identify potentially challenging lesions for “EMR-naïve” endoscopists developing competency.

Methods Consecutive EMRs were recruited from a single center over 130 months. Lesion characteristics, intraprocedural data, and adverse events were recorded. Challenging lesions with intraprocedural bleeding (IPB), intraprocedural perforation (IPP), or unsuccessful resection were identified and predictive variables identified. Significant variables were used to form a numerical score and receiver operating characteristic curves were used to generate cutoff values.

Results Of 1993 LNPCPs, 286 (14.4 %) were in challenging locations (anorectal junction, ileocecal valve, or appendiceal orifice), 368 (18.5 %) procedures were complicated by IPB and 77 (3.9 %) by IPP; 110 (5.5 %) procedures were unsuccessful. The composite end point of IPB, IPP, or unsuccessful EMR was present in 526 cases (26.4 %). Lesion size, challenging location, and sessile morphology were predictive of the composite outcome. A six-point score was generated with a cutoff value of 2 demonstrating 81 % sensitivity across the training and validation cohorts.

Conclusions The EMR-CSS is a novel case selection tool for conventional EMR training, which identifies a subset of adenomatous LNPCPs that can be successfully and safely attempted in early EMR training.

Figs. 1 s–3 s, Table 1 s



Publikationsverlauf

Eingereicht: 22. Dezember 2022

Angenommen nach Revision: 30. Juni 2023

Accepted Manuscript online:
30. Juni 2023

Artikel online veröffentlicht:
09. August 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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