Does completing advanced endoscopy fellowship improve outcomes after endoscopic mucosal resection?

Area of Science:

• Gastroenterology
• Endoscopic Procedures
• Colorectal Cancer Prevention

Background:

• Many US physicians feel unprepared for large polyp resection during Gastroenterology fellowship.
• Endoscopic mucosal resection (EMR) is a key technique for large polyp removal.
• Variability in EMR skill may impact patient outcomes.

Purpose of the Study:

• To compare the efficacy and complication rates of EMR for large colonic polyps.
• To evaluate polyp recurrence rates based on endoscopist expertise.
• To identify potential gaps in EMR training.

Main Methods:

• Retrospective analysis of 140 patients undergoing EMR for large colonic polyps.
• Data collected on patient demographics, polyp characteristics, and endoscopist skill.
• Kaplan-Meier curves used to estimate polyp recurrence risks.

Main Results:

• Advanced endoscopists demonstrated lower polyp recurrence rates compared to skilled gastroenterologists.
• Median recurrence-free survival was significantly longer for patients treated by advanced endoscopists (3.99 years) versus skilled gastroenterologists (0.88-1.03 years).
• Piecemeal resection was common in both groups, but recurrence differed.

Conclusions:

• Polyp recurrence rates vary significantly based on endoscopist expertise in EMR.
• The findings suggest a need for enhanced EMR training for general gastroenterologists.
• Improving EMR skills can lead to better long-term outcomes for patients with large polyps.