A STEEP EARLY LEARNING CURVE FOR ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD) IN THE LIVE PORCINE MODEL

2020 ◽  
Author(s):  
RK Magalhães ◽  
M Dinis-Ribeiro ◽  
MJ Bruno ◽  
R Marcos-Pinto ◽  
C Rolanda ◽  
...  
Keyword(s):  
Learning Curve ◽  
Endoscopic Submucosal Dissection ◽  
Porcine Model ◽  
Early Learning ◽  
Submucosal Dissection

scholarly journals A steep early learning curve for Endoscopic Submucosal Dissection (ESD) in the live porcine model

2021 ◽  
Author(s):  
Ricardo Küttner Magalhães ◽  
Mário Dinis-Ribeiro ◽  
Marco J. Bruno ◽  
Ricardo Marcos-Pinto ◽  
Carla Rolanda ◽  
...  
Keyword(s):  
Adverse Events ◽  
Learning Curve ◽  
Endoscopic Submucosal Dissection ◽  
Porcine Model ◽  
Negative Impact ◽  
Early Learning ◽  
En Bloc ◽  
Live Animal ◽  
Submucosal Dissection ◽  
High Level

Background: Endoscopic Submucosal Dissection (ESD) is a demanding procedure requiring high level of expertise. ESD training programs incorporate procedures with live animal models. This study aimed to assess the early learning curve for performing ESD on live porcine models by endoscopists without any or limited previous ESD experience. Methods: In a live porcine model ESD workshop, number of resections, completeness of the resections, en bloc resections, adverse events, tutor intervention, type of knife, ESD time and size of resected specimens were recorded. ESD speed was calculated. Results: A total of 70 procedures were carried out by 17 trainees. The percentage of complete resections, en bloc resections and ESD speed increased from the first to the latest procedures (88,2% to 100%; 76,5% to 100%; 8,6 to 31,4mm2/min, respectively). The number of procedures in which a trainee needed tutor intervention and the number of adverse events also decreased throughout the procedures (4 to 0 and 6 to 0, respectively). During the workshop, when participants changed to a different type of knife, ESD speed slightly decreased (18,5mm2/min to 17,0mm2/min) and adverse events increased again (0 to 2). Conclusions: Through successive procedures, complete resections, en bloc resections and ESD speed improve whereas adverse events decrease, supporting the role of the live porcine model in the preclinical learning phase. Changing ESD knives has a momentarily negative impact on the learning curve.

scholarly journals N-acetylcysteine for the prevention of stricture after circumferential endoscopic submucosal dissection of the esophagus: a randomized trial in a porcine model

2012 ◽  
Vol 5 (1) ◽  
pp. 8 ◽  
Author(s):  
Maximilien Barret ◽  
Frédéric Batteux ◽  
Frédéric Beuvon ◽  
Luigi Mangialavori ◽  
Ariane Chryssostalis ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Randomized Trial ◽  
Porcine Model ◽  
Submucosal Dissection

scholarly journals Endoscopic submucosal dissection of 301 large colorectal neoplasias: outcome and learning curve from a specialized center in Europe

2018 ◽  
Vol 06 (11) ◽  
pp. E1340-E1348 ◽  
Author(s):  
Carl-Fredrik Rönnow ◽  
Noriya Uedo ◽  
Ervin Toth ◽  
Henrik Thorlacius
Keyword(s):  
Learning Curve ◽  
Endoscopic Submucosal Dissection ◽  
Colorectal Neoplasia ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
High Rate ◽  
R0 Resection ◽  
En Bloc ◽  
Submucosal Dissection ◽  
Immediate Bleeding

Abstract Background and study aims Endoscopic submucosal dissection (ESD) allows en bloc resection of large colorectal lesions but ESD experience is limited outside Asia. This study evaluated implementation of ESD in the treatment of colorectal neoplasia in a Western center. Patients and methods Three hundred and one cases of colorectal ESD (173 rectal and 128 colonic lesions) were retrospectively evaluated in terms of outcome, learning curve and complications. Results Median size was 4 cm (range 1 – 12.5). En bloc resection was achieved in 241 cases amounting to an en bloc resection rate of 80 %. R0 resection was accomplished in 207 cases (69 %), RX and R1 were attained in 83 (27 %) and 11 (4 %) cases, respectively. Median time was 98 min (range 10 – 588) and median proficiency was 7.2 cm2/h. Complications occurred in 24 patients (8 %) divided into 12 immediate perforations, five delayed perforations, one immediate bleeding and six delayed bleedings. Six patients (2 %), all with proximal lesions, had emergency surgery. Two hundred and four patients were followed up endoscopically and median follow-up time was 13 months (range 3 – 53) revealing seven recurrences (3 %). En bloc rate improved gradually from 60 % during the first period to 98 % during the last period. ESD proficiency significantly improved between the first study period (3.6 cm2/h) and the last study period (10.8 cm2/h). Conclusions This study represents the largest material on colorectal ESD in the west and shows that colorectal ESD can be implemented in clinical routine in western countries after appropriate training and achieve a high rate of en bloc and R0 resection with a concomitant low incidence of complications. ESD of proximal colonic lesions should be attempted with caution during the learning curve because of higher risk of complications.

P.1.92: LEARNING CURVE FOR ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD) OF COLORECTAL LESIONS IN A WESTERN ENDOSCOPIC CENTER

2011 ◽  
Vol 43 ◽  
pp. S178-S179
Author(s):  
F. Iacopini ◽  
P. Rigato ◽  
T. Gotoda ◽  
W. Elisei ◽  
C. Grossi ◽  
...  
Keyword(s):  
Learning Curve ◽  
Endoscopic Submucosal Dissection ◽  
Submucosal Dissection
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