The relationship between the esophageal endoscopic submucosal dissection technical difficulty and its intraoperative...

Area of Science:

• Gastroenterology
• Surgical Innovation
• Artificial Intelligence in Medicine

Background:

• Estimating esophageal endoscopic submucosal dissection (ESD) technical difficulty is crucial for minimizing patient complications.
• Endoscopic procedure duration is a recognized factor influencing technical difficulty.
• This study explores the link between esophageal ESD technical difficulty and its intraoperative phases.

Purpose of the Study:

• To analyze the relationship between esophageal ESD technical difficulty and its intraoperative process.
• To establish a foundation for automatic technical difficulty recognition using artificial intelligence (AI).

Main Methods:

• Seventy-five patients with superficial esophageal cancer undergoing ESD were enrolled.
• A technical difficulty score was developed, incorporating procedure duration, en bloc resection, and complications.
• Perioperative factors, specifically the intraoperative process, were investigated as predictors of technical difficulty.

Main Results:

• 11% of patients were classified as high difficulty, while 89% were low difficulty.
• The intraoperative process, defined by the duration of endoscopic phases, showed a significant correlation with technical difficulty.
• The submucosal dissection phase (AUC 0.902), marking phase (AUC 0.827), and early phase (AUC 0.847) were strongly associated with technical difficulty.

Conclusions:

• The intraoperative process, particularly the early phase, is a strong indicator of esophageal ESD technical difficulty.
• This research highlights the potential for AI-driven systems to automatically evaluate esophageal ESD technical difficulty.