scholarly journals Endoscopic Submucosal Dissection (ESD) skills transfer to clinical practice after hands-on workshops: an international survey

2021 ◽  
Author(s):  
Ricardo Küttner Magalhães ◽  
Mário Dinis-Ribeiro ◽  
Ricardo Marcos-Pinto ◽  
Carla Rolanda ◽  
Arjun D. Koch
Keyword(s):  
Clinical Practice ◽  
Endoscopic Submucosal Dissection ◽  
Clinical Outcomes ◽  
Training Programs ◽  
Ex Vivo ◽  
R0 Resection ◽  
Resection Rate ◽  
Live Animal ◽  
Submucosal Dissection ◽  
Hands On

Background Endoscopic submucosal dissection (ESD) is a complex procedure, requiring enhanced technical skills. Translation into clinical practice of ESD training programs has not been documented. Our aim was to assess ESD training pathways of endoscopists participating in dedicated workshops and its clinical impact on ESD outcomes. Methods Participants of live porcine models ESD workshops, from 2013 to 2019, were included. They were invited to complete a survey focusing in human ESD performance after training, prior skills/competencies, complete learning pathway and clinical outcomes. Results From 118 invited participants, 40 (34%) completed the questionnaire. Nineteen (47%) endoscopists performed human ESD after the workshop, predominantly male (89%). At the beginning of human ESD, endoscopists had a mean of 7,7 (SD 4,1) years of endoscopic experience and were all performing endoscopic mucosal resection (EMR) and emergency endoscopy. Before ESD practice, 100% trained with live animal models and 68% with ex vivo models. The majority started clinical ESD in the lower third of the stomach or rectum (90%), with lesions ≤30mm (89%). Each endoscopist performed a median of 19 (IQR 8-32) cumulative ESDs, over a mean of 3,9 (SD 2,0) years. Total en bloc resection rate was 92%, R0 resection rate 88%, curative resection rate 86%, whereas adverse events remained <10%. Endoscopists with >10 human ESD procedures achieve clinical competence thresholds. Conclusions Participants of ESD workshops are adequately skilled prior to clinical ESD, complying with recommendations for training and properly implementing the technique. Transfer to clinical practice, of prior ESD skills obtained in hands-on training courses was documented. Structured training programs achieve clinical outcomes exceeding established standards, namely in the very initial clinical phase.

scholarly journals Multi-loop traction device facilitates gastric endoscopic submucosal dissection: ex vivo pilot study and an inaugural clinical experience

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Hiroaki Matsui ◽  
Naoto Tamai ◽  
Toshiki Futakuchi ◽  
Shunsuke Kamba ◽  
Akira Dobashi ◽  
...  
Keyword(s):  
Pilot Study ◽  
Endoscopic Submucosal Dissection ◽  
Clinical Outcomes ◽  
Ex Vivo ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
R0 Resection ◽  
En Bloc ◽  
Submucosal Dissection ◽  
Traction Device

Abstract Background Endoscopic submucosal dissection (ESD) is technically difficult and requires considerable training. The authors have developed a multi-loop traction device (MLTD), a new traction device that offers easy attachment and detachment. We aimed to evaluate the utility of MLTD in ESD. Methods This ex vivo pilot study was a prospective, block-randomized, comparative study of a porcine stomach model. Twenty-four lesions were assigned to a group that undertook ESD using the MLTD (M-ESD group) and a group that undertook conventional ESD (C-ESD group) to compare the speed of submucosal dissection. In addition, the data of consecutive 10 patients with eleven gastric lesions was collected using electronic medical records to clarify the inaugural clinical outcomes of gastric ESD using MLTD. Results The median (interquartile range) speed of submucosal dissection in the M-ESD and C-ESD groups were 141.5 (60.9–177.6) mm2/min and 35.5 (20.8–52.3) mm2/min, respectively; submucosal dissection was significantly faster in the M-ESD group (p < 0.05). The rate of en bloc resection and R0 resection was 100% in both groups, and there were no perforation in either group. The MLTD attachment time was 2.5 ± 0.9 min and the MLTD extraction time was 1.0 ± 1.1 min. Clinical outcomes of MLTD in gastric ESD were almost the same as those of ex vivo pilot study. Conclusions MLTD increased the speed of submucosal dissection in ESD and was similarly effective when used by expert and trainee endoscopists without perforation. MLTD can potentially ensure a safer and faster ESD.

scholarly journals Acceptability of endoscopic submucosal dissection for sessile serrated lesions: comparison with non-sessile serrated lesions

2020 ◽  
Vol 08 (12) ◽  
pp. E1832-E1839
Author(s):  
Yuichiro Kuroki ◽  
Toshiyuki Endo ◽  
Kenta Iwahashi ◽  
Naoki Miyao ◽  
Reika Suzuki ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Postoperative Bleeding ◽  
En Bloc Resection ◽  
Tumor Location ◽  
Proximal Colon ◽  
R0 Resection ◽  
Resection Rate ◽  
En Bloc ◽  
Submucosal Dissection ◽  
Serrated Lesions

Abstract Background and study aims Sessile serrated lesions (SSL) are major precursor lesions of serrated pathway cancers, and appropriate treatment may prevent interval colorectal cancer. Studies have reported the outcomes of endoscopic mucosal resection (EMR) for SSL; however, there are insufficient reports on endoscopic submucosal dissection (ESD). We examined the characteristics and outcomes of SSL and compared them to those of non-SSL in ESD. Patients and methods We reviewed 370 consecutive cases in 322 patients who underwent colorectal ESD between January 2016 and March 2020 at our hospital. There were 267 0-IIa lesions that were stratified into 41 SSL and 226 non-SSL (intramucosal cancer, adenoma) cases. We used propensity matching to adjust for the variances in the factors affecting treatment between the SSL and non-SSL groups. Results In the baseline cases, young women and proximal colon tumor location were significantly more common in the SSL group. There were no statistically significant differences between the SSL and non-SSL groups in terms of en bloc resection rate (97.6 % vs. 99.6 %; P = 0.28), R0 resection rate (92.7 % vs. 93.4 %; P = 0.74), perforation (0 % vs. 0.9 %; P > 0.99), and postoperative bleeding (2.4 % vs. 1.8 %; P = 0.56). Thirty-eight pairs were matched using propensity score, and the median dissection speed (12 vs. 7.7 cm2/h; P = 0.0095) was significantly faster in the SSL than in the non-SSL group. Conclusions ESD for SSL was safely performed, and SSL was smoother to remove than non-SSL. ESD might be an acceptable endoscopic treatment option for SSL.

scholarly journals Colorectal Endoscopic Submucosal Dissection in a Western Center: Analysis of Outcomes and Safety Profile

2021 ◽  
pp. 1-9
Author(s):  
João Santos-Antunes ◽  
Margarida Marques ◽  
Rui Morais ◽  
Fátima Carneiro ◽  
Guilherme Macedo
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Safety Profile ◽  
En Bloc Resection ◽  
R0 Resection ◽  
Hybrid Technique ◽  
Resection Rate ◽  
En Bloc ◽  
Delayed Bleeding ◽  
Submucosal Dissection ◽  
Gastrointestinal Lesions

<b><i>Introduction:</i></b> Endoscopic submucosal dissection (ESD) is a well-established endoscopic technique for the treatment of gastrointestinal lesions. Colorectal ESD outcomes are less reported in the Western literature, and Portuguese data are still very scarce. Our aim was to describe our experience on colorectal ESD regarding its outcomes and safety profile. <b><i>Methods:</i></b> We conducted a retrospective evaluation of recorded data on ESDs performed between 2015 and 2020. Only ESDs performed on epithelial neoplastic lesions were selected for further analysis. <b><i>Results:</i></b> Of a total of 167 colorectal ESDs, 153 were included. Technical success was achieved in 147 procedures (96%). The lesions were located in the colon (<i>n</i> = 24) and rectum (<i>n</i> = 123). The en bloc resection rate was 92% and 97%, the R0 resection rate was 83% and 82%, and the curative resection rate was 79% and 78% for the colon and the rectum, respectively. The need for a hybrid technique was the only risk factor for piecemeal or R1 resection. We report a perforation rate of 3.4% and a 4.1% rate of delayed bleeding; all the adverse events were manageable endoscopically, without the need of blood transfusions or surgery. Most of the lesions were laterally spreading tumours of the granular mixed type (70%), and 20% of the lesions were malignant (12% submucosal and 8% intramucosal cancer). <b><i>Conclusion:</i></b> Our series on colorectal ESD reports a very good efficacy and safety profile. This technique can be applied by endoscopists experienced in ESD.

scholarly journals Endoscopic submucosal dissection in management of colorectal tumors near or involving a diverticulum: a retrospective case series

2019 ◽  
Vol 07 (05) ◽  
pp. E664-E671 ◽  
Author(s):  
Victoria Jimenez-Garcia ◽  
Masayoshi Yamada ◽  
Hiroaki Ikematsu ◽  
Hiroyuki Takamaru ◽  
Seiichiro Abe ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Case Series ◽  
Clinicopathological Characteristics ◽  
R0 Resection ◽  
Incomplete Resection ◽  
Colorectal Tumors ◽  
Resection Rate ◽  
Retrospective Case ◽  
En Bloc ◽  
Submucosal Dissection

Abstract Background and study aims Surgery is the standard treatment for colon tumors associated with diverticulum. Use of endoscopic submucosal dissection (ESD) to treat such tumors is controversial. The aim of this study was to assess the safety and feasibility of ESD in treating superficial colorectal tumors situated near or involving diverticulum. Patients and methods Consecutive patients from two referral centers who had colorectal tumors near or involving diverticulum treated by ESD were retrospectively studied. Clinicopathological characteristics and clinical outcomes were analyzed. Results Of the 12 patients studied, six had tumors near diverticulum and six had tumors involving diverticulum. The overall en-bloc R0 resection rate, median tumor size and procedure time were 67 %, 26.5 mm (range, 15 – 80 mm) and 110 minutes (range, 50 – 220 minutes), respectively. For tumors near diverticulum group, the en-bloc R0 resection rate was 100 % and no adverse events (AEs) or residual/recurrent tumors were observed. In contrast, for intradiverticular tumors group, the en-bloc R0 resection rate was low at 33 %, and one AE (perforation) was observed. The diverticula were ≥ 6 mm in diameter in the patients with incomplete resection. However, all but one diverticulum was unrecognized before ESD. Two residual tumors were detected at the 12-month surveillance and one required surgery. Conclusions This case series indicates that ESD is safe and feasible for treating colorectal tumors near a diverticulum and might be feasible for tumors involving a diverticulum smaller than 6 mm. Selection for smaller diverticulum size may contribute to higher en-bloc R0 resection rates.

scholarly journals Clinical outcomes of early gastric cardiac cancer treated with endoscopic submucosal dissection in patients with different indications

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ting Fan ◽  
Qi Sun ◽  
Shouli Cao ◽  
Xiangshan Fan ◽  
Qin Huang ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Clinical Outcomes ◽  
Resection Rate ◽  
En Bloc ◽  
Cardiac Cancer ◽  
Submucosal Dissection ◽  
Metastasis Rate ◽  
Distant Metastasis Rate

Abstract Background Endoscopic submucosal dissection (ESD) has been accepted as a standard treatment for early gastric cardiac cancer (EGCC). Here, we investigate the clinical outcomes of the EGCC patients who underwent ESD in different indications. Methods From January 2011 to October 2019, we enrolled 502 EGCC lesions from 495 patients which were resected by ESD at our center. We retrospectively analyzed the short-term and long-term clinical outcomes among different indication groups. Results The number of the patients in the absolute indication (AI), expanded indication (EI) and beyond the expanded indication (BEI) groups was 265, 137 and 93, respectively. The en bloc resection rate was 100%, 100% and 98.9% (P = 0.185). The complete resection rate was 99.3%, 98.5% and 74.5%, respectively (P < 0.001). During a median follow-up of 48.1 months, the lymph node metastasis rate was 0%, 0% and 2.3% (P < 0.001). The distant metastasis rate was 0.4%, 0% and 2.3% (P = 0.150). The five-year disease-specific survival rate in the BEI group was 96.6% (P = 0.016), compared to 99.6% in the AI group and 100% in the EI group. Conclusion The efficacy for ESD patients in EI group was almost equal to the AI group. Patients in the BEI group showed generally favorable clinical outcomes and needed to be carefully checked after ESD. ESD may be an optional treatment for patients unsuitable for gastrectomy.

scholarly journals Esophageal Endoscopic Submucosal Dissection Assisted by an Overtube with a Traction Forceps: An Animal Study

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Ken Ohata ◽  
Kuangi Fu ◽  
Eiji Sakai ◽  
Kouichi Nonaka ◽  
Tomoaki Tashima ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Clinical Outcomes ◽  
Animal Study ◽  
Ex Vivo ◽  
Target Lesion ◽  
En Bloc ◽  
Submucosal Dissection ◽  
Muscular Injury ◽  
Mucosal Incision ◽  
Novel Method

Esophageal endoscopic submucosal dissection (ESD) is technically difficult. To make it safer, we developed a novel method using overtube with a traction forceps (OTF) for countertraction during submucosal dissection. We conducted anex vivoanimal study and compared the clinical outcomes between OTF-ESD and conventional method (C-ESD). A total of 32 esophageal ESD procedures were performed by four beginner and expert endoscopists. After circumferential mucosal incision for the target lesion, structured as the isolated pig esophagus 3 cm long, either C-ESD or OTF-ESD was randomly selected for submucosal dissection. All the ESD procedures were completed as en bloc resections, while perforation only occurred in a beginner’s C-ESD procedure. The dissection time for OTF-ESD was significantly shorter than that for C-ESD for both the beginner and expert endoscopists (22.8±8.3 min versus7.8±4.5 min,P<0.001, and11.3±4.4 min versus5.9±2.5 min,P=0.01, resp.). The frequency and volume of the submucosal injections were significantly smaller for OTF-ESD than for C-ESD (1.3±0.6times versus2.9±1.5times,P<0.001, and5.3±2.8 mL versus15.6±7.3 mL,P<0.001, resp.). Histologically, muscular injury was more common among the C-ESD procedures (80% versus 13%,P=0.009). Our results indicated that the OTF-ESD technique is useful for the safe and easy completion of esophageal ESD.

scholarly journals Clinical Outcomes and Adverse Events of Endoscopic Submucosal Dissection for Gastric Tube Cancer after Esophagectomy

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Ko Watanabe ◽  
Takuto Hikichi ◽  
Jun Nakamura ◽  
Minami Hashimoto ◽  
Tadayuki Takagi ◽  
...  
Keyword(s):  
Adverse Events ◽  
Endoscopic Submucosal Dissection ◽  
Clinical Outcomes ◽  
Gastric Tube ◽  
Curative Resection ◽  
Postoperative Bleeding ◽  
Resection Rate ◽  
En Bloc ◽  
Gastric Tube Cancer ◽  
Submucosal Dissection

Background and Aim. The clinical outcomes of endoscopic submucosal dissection (ESD) for gastric tube cancer (GTC) after esophagectomy remain unclear. The aim of this study was to evaluate the clinical outcomes and safety of ESD for GTC. Patients and Methods. Twenty GTC lesions in 18 consecutive patients who underwent ESD between February 2008 and June 2018 were included in this retrospective study. The endpoints were the treatment outcomes of ESD (i.e., en bloc resection rate, complete en bloc resection rate, and curative resection rate), the adverse events following ESD, and the long-term outcomes. Results. The en bloc resection rate was 100%, while the complete en bloc resection rate and curative resection rate were 80% each. Adverse events were observed in 16.7% (3/18) of patients: one postoperative bleeding, 1 intraoperative perforation that required emergency surgery, and 1 pyothorax that required chest drainage. The 1-, 3-, and 5-year overall survival rates were 100%, 70.9%, and 70.9%, respectively. Although local recurrence was detected in 1 case of noncurative resection, no GTC- or ESD-related deaths were observed. Conclusion. ESD for GTC was feasible and acceptable to enable en bloc resection and to prevent cancer death. However, ESD for GTC should be performed more carefully than common gastric ESD because serious adverse events specific to the gastric tube may occur.

scholarly journals Clinical outcomes of early gastric cardiac cancer treated with endoscopic submucosal dissection in patients with different indications

2020 ◽  
Author(s):  
Ting Fan ◽  
Qi Sun ◽  
Shouli Cao ◽  
Xiangshan Fan ◽  
Qin Huang ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Clinical Outcomes ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Resection Rate ◽  
En Bloc ◽  
Cardiac Cancer ◽  
Submucosal Dissection ◽  
Metastasis Rate

Abstract Background: Endoscopic submucosal dissection (ESD) has been accepted as a standard treatment for early gastric cardiac cancer (EGCC). Here, we investigate the clinical outcomes of the EGCC patients who underwent ESD in different indications. Methods: From January 2011 to October 2019, we enrolled 502 EGCC lesions from 495 patients which were resected by ESD at our center. We retrospectively analyzed the short-term and long-term clinical outcomes among different indication groups. Results: The number of the patients in the absolute indication (AI), expanded indication (EI) and beyond the expanded indication (BEI) groups was 265, 137 and 93, respectively. The en bloc resection rate was 100%, 100% and 98.9% ( P =0.185). The complete resection rate was 99.3%, 98.5% and 74.5%, respectively ( P <0.001). During a median follow-up of 48.1 months, the lymph node metastasis rate was 0%, 0% and 2.3% ( P <0.001). The distant metastasis rate was 0.4%, 0% and 2.3% ( P =0.150). The five-year disease-specific survival rate in the BEI group was 96.6% ( P =0.016), compared to 99.6% in the AI group and 100% in the EI group. Conclusion: The efficacy for ESD patients in EI group was almost equal to the AI group. Patients in the BEI group showed generally favorable clinical outcomes and needed to be carefully checked after ESD. ESD may be an optional treatment for patients unsuitable for gastrectomy.

scholarly journals ENDOSCOPIC SUBMUCOSAL DISSECTION WITH CIRCUMFERENTIAL INCISION VERSUS TUNNELING METHOD FOR TREATMENT OF SUPERFICIAL ESOPHAGEAL CANCER

2021 ◽  
Author(s):  
Tarso Magno Leite RIBEIRO ◽  
Vitor N ARANTES ◽  
Jonas Augusto RAMOS ◽  
Peter V DRAGANOV ◽  
Dennis YANG ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Local Recurrence ◽  
Adverse Events ◽  
Endoscopic Submucosal Dissection ◽  
Curative Resection ◽  
R0 Resection ◽  
Resection Rate ◽  
Superficial Esophageal Cancer ◽  
En Bloc ◽  
Submucosal Dissection

ABSTRACT BACKGROUND: Endoscopic submucosal dissection (ESD) of esophageal superficial neoplasm is associated with a high en bloc R0 resection rate and low recurrence. OBJECTIVE: We aim to compare the performance and clinical outcomes of ESD via ESD after circumferential incision (ESD-C) versus submucosal tunneling (ESD-T). METHODS: Single-center retrospective analysis of all consecutive patients who underwent ESD for superficial esophageal cancer, between 2009 and 2018. ESD-T was defined as the technique of making the mucosal incisions followed by submucosal tunneling in the oral to anal direction. ESD-C consisted of completing a circumferential incision followed by ESD. Main study outcomes included en bloc and R0 resection rates. Secondary outcomes included procedural characteristics, curative resection rate, local recurrence and adverse events. RESULTS: A total of 65 procedures (23 ESD-T and 42 ESD-C) were performed for ESCC (40; 61.5%) and BE-neoplasia (25; 38.5%). There were no statistically significant differences between patients who underwent ESD-T versus ESD-C in en bloc (91.3% vs 100%, P=0.12), R0 (65.2% vs 78.6%, P=0.24), curative resection rates (65.2% vs 73.8%, P=0.47) and mean procedure time (118.7 min with vs 102.4 min, P=0.35). Adverse events for ESD-T and ESD-C were as follows: bleeding (0 versus 2.4%; P=0.53), perforation (4.3% vs 0; P=0.61), esophageal stricture (8.7% versus 9.5%; P=0.31). Local recurrence was encountered in 8.7% after ESD-T and 2.4% after ESD-C (P=0.28) at a mean follow-up of 8 and 2.75 years, respectively (P=0.001). CONCLUSION: ESD-T and ESD-C appear to be equally effective with similar safety profiles for the management of superficial esophageal neoplasms.

Clinical Outcomes of Endoscopic Submucosal Tunnel Dissection Vs Endoscopic Submucosal Dissection in Gastric Lesions: a Systematic Review and Meta-analysis

2021 ◽  
Author(s):  
Jianglei Li ◽  
Mengmeng Xu ◽  
Yuyong Tan ◽  
Yongjun Wang ◽  
Deliang Liu
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Clinical Outcomes ◽  
Recurrence Rate ◽  
Precancerous Lesions ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Gastric Lesions ◽  
Resection Rate ◽  
En Bloc ◽  
Submucosal Dissection

Abstract Background and objectives: Many studies have verified that endoscopic submucosal dissection (ESD) has prominent advantages in en bloc resection and low recurrence rate. However, ESD also has technical difficulty for some large-area gastric lesions. Endoscopic submucosal tunneling dissection (ESTD) combined the tunnel technique with the traditional ESD technique for treating gastrointestinal mucosal lesions under tunnel endoscopy. This technique has been gradually applied to the treatment of large-scale early cancer and precancerous lesions, and has achieved good results. Yet no meta-analysis has been published, so we performed this study to determine the efficacy and safety of ESTD vs ESD in gastric lesions through clinical outcomes.Methods: We performed the literature search in PubMed, Cochrane Library, Web of Science, Embase, Wanfang, and CNKI dating up to February 9, 2021. Studies comparing the clinical outcomes of ESTD and ESD in gastric lesions were enrolled. The Newcastle-Ottawa Quality Assessment Scale was used to evaluate the quality of these studies. Results: Four articles were included that involved a total of 920 patients (187 from the ESTD group and 733 from ESD group). ESTD has higher en bloc resection and R0 resection rate, faster dissection speed, and lower complication rate. The curative resection rate and recurrence rate of ESTD group is comparable with ESD group.Conclusions: ESTD technique is an effective and safe treatment procedure in gastric lesions, and may be prior to ESD for large gastric lesions.

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