Untutored learning curve to establish endoscopic submucosal dissection on competence level

Area of Science:

• Gastroenterology
• Endoscopy
• Surgical Oncology

Background:

• Endoscopic submucosal dissection (ESD) enables precise staging and organ preservation for early gastrointestinal cancers.
• While ESD is widespread in Japan, Western countries face challenges in untutored learning due to lower prevalence of suitable lesions.
• A step-up approach focusing on simpler gastric lesions is insufficient in Western settings.

Purpose of the Study:

• To evaluate the feasibility of untutored endoscopic submucosal dissection (ESD) learning in Western countries.
• To assess the efficacy and safety of a prevalence-based approach for ESD training.
• To determine the suitability of colonic lesions for initial ESD training.

Main Methods:

• Analysis of an initial series of 50 untutored ESD procedures performed by an experienced endoscopist.
• Inclusion of consecutive lesions referred based on prevalence, encompassing both upper gastrointestinal and colorectal sites.
• Systematic documentation of resection success, complication rates, and patient outcomes.

Main Results:

• Complete resection was achieved in 48 of 50 lesions (96%) intention-to-treat, with 80% being colorectal.
• En-bloc resection was successful in 76% of neoplastic lesions.
• No recurrence was observed in 15 neoplasias with high-grade intraepithelial neoplasia or early esophageal cancer (R0).
• Complications included 4% bleeding and 14% perforation, with most managed conservatively.

Conclusions:

• Untutored learning of endoscopic submucosal dissection (ESD) is achievable using colonic lesions.
• A prevalence-of-lesions-based approach is effective for establishing ESD in Europe.
• Structured training programs are recommended to facilitate widespread adoption of ESD in Western healthcare systems.