scholarly journals USEFULNESS OF GASTRIC SUBMUCOSAL DISSECTION DEPTH TO EVALUATE SKILL ACQUIREMENT IN SHORT TERM TRAINING COURSES IN ESD: AN EXPERIMENTAL STUDY

2018 ◽  
Vol 55 (3) ◽  
pp. 221-229 ◽  
Author(s):  
Kendi YAMAZAKI ◽  
Eduardo Guimarães Hourneaux de MOURA ◽  
Mariana Matera VERAS ◽  
Luiz Henrique MESTIERI ◽  
Paulo SAKAI
Keyword(s):  
Experimental Study ◽  
Adverse Events ◽  
Learning Curve ◽  
Intraoperative Complications ◽  
Gastric Body ◽  
Short Term ◽  
Roc Curve Analysis ◽  
The Third ◽  
Submucosal Dissection ◽  
Training Courses

ABSTRACT BACKGROUND: Endoscopic submucosal dissection (ESD) is a complex endoscopic procedure, with high rates of adverse events and technical difficulties. To overcome that problem, many training centers published the importance of animal models for skill acquirement in ESD. However, no study has used the submucosal dissection depth (DSUB) as a parameter to evaluate the learning curve in ESD, which might be a relevant factor since an optimal resection plane is important to achieve a curative resection and avoid intraoperative complications. OBJECTIVE: This study aimed to assess ESD skill acquirement after short-term training sessions by evaluating the submucosal dissection depth (DSUB) and the association with adverse events. METHODS: This experimental study included 25 experienced endoscopists in therapeuthic procedures (>5years) and 75 specimens resected by ESD (three resections / endoscopist). Learning parameters (resection time, size, en bloc resection rate, bleeding, perforation and submucosal dissection depth) were prospectively evaluated. The percentages of DSUB of all specimens resected were calculated. RESULTS: All specimens were resected from the gastric body (n=75). The mean size of the resected specimens was 23.97±7.2 mm. The number of adverse events, including bleeding, perforation, and death, were 17 (22.67%), 3 (4%), and 0 cases, respectively. The average mean time by the third dissection decreased from 28.44±9.73 to 18.72±8.81 min (P<0.001). The proportion of DSUB in the bleeding and non-bleeding group were respectively 37.97%±21.13% and 68.66%±23.99%, indicating a significant association between DSUB and bleeding incidence (P<0.001). The ROC curve analysis indicated a cut-off point of 61% (sensitivity, 64%; specificity, 94%) of submucosal dissection depth associated with bleeding. Therefore, when ESD was performed at a depth of >61% of the submucosal layer, the risk for bleeding during the procedure decreased (PPV, 0.97; 95% CI, 0.85-0.99). CONCLUSION: Improvement in the learning curve in ESD and a better cognitive ability were seen by the third dissection in these short term training courses. And a significant association between DSUB and the risk of bleeding.

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.

Impact of operative time on short-term adverse events following total shoulder arthroplasty

2020 ◽  
Vol 30 (3) ◽  
pp. 227-236
Author(s):  
Kevin I. Kashanchi ◽  
Alireza K. Nazemi ◽  
David E. Komatsu ◽  
Edward D. Wang
Keyword(s):  
Adverse Events ◽  
Shoulder Arthroplasty ◽  
Operative Time ◽  
Total Shoulder Arthroplasty ◽  
Short Term

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 Severe Hyperkalemia: Can the Electrocardiogram Risk Stratify for Short-term Adverse Events?

2017 ◽  
Vol 18 (5) ◽  
pp. 963-971 ◽  
Author(s):  
Nicole Durfey ◽  
Brian Lehnhof ◽  
Andrew Bergeson ◽  
Shayla Durfey ◽  
Victoria Leytin ◽  
...  
Keyword(s):  
Adverse Events ◽  
Short Term ◽  
Severe Hyperkalemia

scholarly journals Longitudinal Circulating Levels of miR-23b-3p, miR-126-3p and lncRNA GAS5 in HCC Patients Treated with Sorafenib

Biomedicines ◽  
2021 ◽  
Vol 9 (7) ◽  
pp. 813
Author(s):  
Michele Manganelli ◽  
Ilaria Grossi ◽  
Manuela Ferracin ◽  
Paola Guerriero ◽  
Massimo Negrini ◽  
...  
Keyword(s):  
Digital Pcr ◽  
Droplet Digital Pcr ◽  
Healthy Individuals ◽  
Roc Curve Analysis ◽  
Multikinase Inhibitor ◽  
Sorafenib Treatment ◽  
The Third ◽  
Circulating Levels ◽  
Systemic Drug

Human hepatocellular carcinoma (HCC) is the most frequent primary tumor of the liver and the third cause of cancer-related deaths. The multikinase inhibitor sorafenib is a systemic drug for unresectable HCC. The identification of molecular biomarkers for the early diagnosis of HCC and responsiveness to treatment are needed. In this work, we performed an exploratory study to investigate the longitudinal levels of cell-free long ncRNA GAS5 and microRNAs miR-126-3p and -23b-3p in a cohort of 7 patients during the period of treatment with sorafenib. We used qPCR to measure the amounts of GAS5 and miR-126-3p and droplet digital PCR (ddPCR) to measure the levels of miR-23b-3p. Patients treated with sorafenib displayed variable levels of GAS5, miR-126-3p and miR-23b-3p at different time-points of follow-up. miR-23b-3p was further measured by ddPCR in 37 healthy individuals and 25 untreated HCC patients. The amount of miR-23b-3p in the plasma of untreated HCC patients was significantly downregulated if compared to healthy individuals. The ROC curve analysis underlined its diagnostic relevance. In conclusion, our results highlight a potential clinical significance of circulating miR-23b-3p and an exploratory observation on the longitudinal plasmatic levels of GAS5, miR-126-3p and miR-23b-3p during sorafenib treatment.

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