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.

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 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.

Ten year experience of esophageal endoscopic submucosal dissection of superficial esophageal neoplasms in a single center.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 104-104
Author(s):  
Hyungchul Park ◽  
Do Hoon Kim ◽  
Eun Jeong Gong ◽  
Hee Kyong Na ◽  
Ji Yong Ahn ◽  
...  
Keyword(s):  
Adverse Events ◽  
Endoscopic Submucosal Dissection ◽  
Survival Rates ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
En Bloc ◽  
Female Ratio ◽  
Submucosal Dissection ◽  
Difficult Procedure ◽  
Male To Female

104 Background: Endoscopic submucosal dissection (ESD) of a superficial esophageal neoplasm (SEN) is a technically difficult procedure. We investigated the clinical outcomes of ESD to determine its feasibility and effectiveness for the treatment of SEN. Methods: Patients who underwent ESD for SEN between August 2005 and June 2014 were eligible for this study. The clinical features of patients and tumors, histopathologic characteristics, adverse events, results of endoscopic resection, and survival were investigated. Results: ESD was performed in 225 patients with 261 lesions, including 70 cases (26.8%) of dysplasias and 191 cases (73.2%) of squamous cell carcinomas. The median age was 65 years (range: 44–86 years), and the male to female ratio was 21.5:1. Median tumor size was 37 mm (range: 5–85 mm) and median procedure time was 45 minutes (range: 9–160 minutes). En bloc resection was performed in 245 of 261 lesions (93.9%), with complete resection in 234 lesions (89.7%) and curative resection in 201 lesions (77.0%). Adverse events occurred in 33 cases (12.6%), including bleeding (1.5%), perforation (4.6%), and stricture (6.5%). During a median follow-up period of 35.0 months (interquartile range: 18–62 months), none of the patients showed local recurrence. The 5-year overall and disease-specific survival rates were 89.7% and 100%, respectively. Conclusions: ESD is a feasible and effective procedure for the treatment of SEN based on our 10-year experience, which showed favorable outcomes.

scholarly journals Endoscopic Submucosal Dissection of Gastric Epithelial Neoplasms after Partial Gastrectomy: A Single-Center Experience

2017 ◽  
Vol 2017 ◽  
pp. 1-8 ◽  
Author(s):  
Byeong Gu Song ◽  
Gwang Ha Kim ◽  
Bong Eun Lee ◽  
Hye Kyung Jeon ◽  
Dong Hoon Baek ◽  
...  
Keyword(s):  
Adverse Events ◽  
Endoscopic Submucosal Dissection ◽  
Partial Gastrectomy ◽  
Remnant Stomach ◽  
Complete Resection ◽  
Incomplete Resection ◽  
En Bloc ◽  
Submucosal Dissection ◽  
Single Center Experience ◽  
Epithelial Neoplasms

Aims. To investigate the feasibility and safety of endoscopic submucosal dissection (ESD) of gastric epithelial neoplasms in the remnant stomach (GEN-RS) after various types of partial gastrectomy. Methods. This study included 29 patients (31 lesions) who underwent ESD for GEN-RS between March 2006 and August 2016. Clinicopathologic data were retrieved retrospectively to assess the therapeutic ESD outcomes, including en bloc and complete resection rates and procedure-related adverse events. Results. The en bloc, complete, and curative resection rates were 90%, 77%, and 71%, respectively. The types of previous gastrectomy, tumor size, macroscopic type, and tumor histology were not associated with incomplete resection. Only tumors involving the suture lines from the prior partial gastrectomy were significantly associated with incomplete resection. The procedure-related bleeding and perforation rates were 6% and 3%, respectively; none of the adverse events required surgical intervention. During a median follow-up period of 25 months (range, 6–58 months), there was no recurrence in any case. Conclusions. ESD is a safe and feasible treatment for GEN-RS regardless of the previous gastrectomy type. However, the complete resection rate decreases for lesions involving the suture lines.

scholarly journals Scissor-type knife improves the safety of endoscopic submucosal dissection (ESD) among endoscopists without experience in ESD: a randomized ex vivo study

2021 ◽  
Vol 09 (08) ◽  
pp. E1207-E1213
Author(s):  
Kavel Visrodia ◽  
Tarek Sawas ◽  
Liam Zakko ◽  
Juan Reyes Genere ◽  
Cadman Leggett ◽  
...  
Keyword(s):  
Adverse Events ◽  
Endoscopic Submucosal Dissection ◽  
Muscle Injury ◽  
Ex Vivo ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Lower Proportion ◽  
Procedure Time ◽  
En Bloc ◽  
Submucosal Dissection

Abstract Background and study aims Endoscopic submucosal dissection (ESD) is technically challenging, difficult to learn, and carries a substantial risk of perforation, all of which remain significant barriers to its adoptability. We aimed to determine whether use of a novel scissor-type knife improved efficacy and safety among novice performers of ESD. Materials and methods Following a brief didactic session on ESD, participants performed ESD of two lesions (2 cm diameter) in an ex vivo porcine gastric model. One resection was performed with a conventional knife and the other with the scissor knife (order of knife randomized). We recorded procedure time, successful en bloc resection, and adverse events (including full-thickness perforation and muscle injury) for each dissection. Participants completed a post-study survey. Results 10 endoscopists (8 trainees, 2 staff) considered novices in ESD participated. Compared with the conventional knife, use of the scissor knife was associated with a significantly shorter time to completion of submucosal dissection (mean 6.2 [SD 5.6] vs. 15.6 [SD 15.6] minutes; P = 0.04) and total procedure time was not significantly different (22.1 [SD 13.3] vs. 24.9 [SD 26.5] minutes; P = 0.65). Scissor knife use was also associated with a significantly lower proportion of perforation and/or muscle injury (10.0 % vs. 70.0 %; P < 0.01) and proportion of muscle injury alone (10.0 % vs. 60.0 %; P  = 0.02). Conclusions Among novices performing ESD on an ex vivo animal model, use of a scissor knife was associated with a significantly lower proportion of adverse events without prolonging procedure time. Scissor-type knives may improve ESD safety, at least among novices.

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 Current Challenge: Endoscopic Submucosal Dissection of Superficial Non-ampullary Duodenal Epithelial Tumors

2020 ◽  
Vol 21 (12) ◽  
Author(s):  
Kazuya Akahoshi ◽  
Masaru Kubokawa ◽  
Kazuki Inamura ◽  
Kazuaki Akahoshi ◽  
Yuki Shiratsuchi ◽  
...  
Keyword(s):  
Adverse Events ◽  
Endoscopic Submucosal Dissection ◽  
Endoscopic Resection ◽  
Early Stage ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
High Rate ◽  
En Bloc ◽  
Submucosal Dissection ◽  
Epithelial Tumors

Opinion statement With the widespread use of esophagogastroduodenoscopy in recent years, the detection rate of superficial non-ampullary duodenal epithelial tumors (SNADETs) is increasing. Most SNADETs are early-stage adenocarcinoma or benign conditions, including adenoma. Therefore, endoscopic resection is desirable from the perspective of quality of life. However, endoscopic resection for SNADETs has not yet been established. Endoscopic submucosal dissection (ESD) is the most promising method for the treatment of SNADETs, because ESD provides a high rate of en bloc resection and a low rate of recurrence regardless of the tumor size. However, the difficulty of the procedure and a high rate of severe adverse events including perforation and bleeding have become major problems. Various preventive countermeasures for adverse events, such as use of specific devices, endoscope stabilization methods, and endoscopic closure of the post-ESD ulcer using clips, are reported to reduce the risk of the adverse events of ESD for SNADETs. This article reviews and highlights the current state of ESD for SNADETs and new challenges towards safe and effective ESD.

scholarly journals IS ENDOSCOPIC SUBMUCOSAL DISSECTION STILL LIMITED TO FEW TERTIARY CENTERS IN THE WEST? RESULTS FROM A NATIONAL SURVEY IN BRAZIL

2020 ◽  
Vol 57 (4) ◽  
pp. 477-483
Author(s):  
Vitor N ARANTES ◽  
Maria das Graças Pimenta SANNA ◽  
Jairo Silva ALVES ◽  
Daniela Medeiros MILHOMEM-CARDOSO ◽  
Fauze MALUF-FILHO
Keyword(s):  
Adverse Events ◽  
Endoscopic Submucosal Dissection ◽  
The West ◽  
En Bloc ◽  
Electronic Survey ◽  
Additional Information ◽  
Submucosal Dissection ◽  
Hands On ◽  
En Bloc Excision ◽  
Bloc Excision

ABSTRACT BACKGROUND: Endoscopic submucosal dissection (ESD) enables en bloc excision of superficial neoplasms. Although ESD is widely practiced in Eastern countries like Japan, South Korea and China, its use in the West is supposed to be still limited to few tertiary centers. OBJECTIVE: This study aimed to investigate the clinical practice of ESD in Brazil by means of an electronic questionnaire elaborated by the Brazilian Society of Digestive Endoscopy (SOBED). METHODS: In October 2019, 3512 endoscopist members of SOBED were invited to respond to an electronic survey containing 40 questions divided into four topics: operator profile; clinical experience with ESD; adverse events and training. Informed consent was requested to all participants. The investigators reviewed all responses and considered valid if more than 50% of the questions were answered and additional information, when requested, was provided. RESULTS: A total of 155 (4.4%) qualified responses entered the study. ESD has been practiced in 22 of 26 Federation States and majority of respondents (32.2%) have 10 to 20 years of practice. ESD has been performed more frequently in private hospitals (101 individuals, 66.9%) and private ambulatory centers (41 individuals, 27.1%). ESD was performed mainly in the stomach (72%), followed by the rectum (57%) and 80% of the individuals reported less than 25 operations. Twenty-four (15.4 %) individuals reported perforation and 4 (2.5%) of them reported postoperative deaths. Approximately a quarter of responders denied hands-on training in models or visit to training centers. CONCLUSION: ESD appears to be practiced throughout the country, not only in tertiary or academic institutions and mainly in private practice. Most operators received limited training and still are at the beginning of their learning curve. The reported adverse events and mortality rates appear to be higher than Eastern reports.

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.

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