Stepwise training in rectal and colonic endoscopic submucosal dissection with differentiated learning curves

Area of Science:

• Gastroenterology
• Endoscopic Surgery
• Medical Training

Background:

• Endoscopic submucosal dissection (ESD) is a key technique for resecting gastrointestinal (GI) superficial neoplasms.
• Adoption of ESD in Western countries lags significantly compared to other regions.
• A standardized training protocol is needed to facilitate ESD implementation.

Purpose of the Study:

• To evaluate a stepwise training protocol for colorectal endoscopic submucosal dissection (ESD).
• To assess the feasibility of ESD adoption by endoscopists expert in therapeutic endoscopy but novice in ESD.

Main Methods:

• Prospective study conducted in a nonacademic Western hospital.
• Training involved unsupervised and supervised ESDs on isolated stomachs and rectums, followed by unsupervised patient procedures.
• Learning curves were analyzed based on en bloc resection rates and operative times per cm², with competence defined by an 80% en bloc rate.

Main Results:

• Thirty rectal and 30 colonic ESDs were performed.
• Rectal ESD achieved an 80% en bloc rate after 5 procedures, with significant operative time reduction after 20 procedures.
• Colonic ESD required 20 procedures to reach an 80% en bloc rate and achieve significant operative time reduction, with minor complications observed.

Conclusions:

• A minimal, intensive training protocol is sufficient for therapeutic endoscopists to adopt ESD.
• Separate learning curves exist for rectal and colonic ESD, suggesting a sequential approach to training.
• This protocol offers a feasible pathway for increasing ESD adoption in Western settings.