Learning Curve of Endoscopic Submucosal Dissection for Early Esophageal Cancer Among Endoscopists with Varying...

Esophageal endoscopic submucosal dissection (E-ESD) is a key treatment modality for early-stage esophageal cancer. However, data on the E-ESD learning curve remains relatively scarce. This study explores E-ESD learning patterns of endoscopists with different experience to inform training.

A 2014-2023 single-center retrospective study analyzed 300 E-ESDs (150 cases each performed by senior endoscopists [SE] and junior endoscopists [JE]), stratified into 3 phases (1-50, 51-100, 101-150 cases). CUSUM and moving averages assessed the learning curve, with key indicators including resection speed, en bloc/R0 rates, and perforation rate.

As case numbers increased, both endoscopists' key indicators improved. SE had significantly higher median resection speed than JE in Phase 1 (5.59 vs. 3.87 cm²/h, P = 0.001) and 3 (10.14 vs. 7.21 cm²/h, P < 0.001). En bloc rates rose to 96% (SE) and 94% (JE); R0 rates to 96% (SE) and 94% (JE) (no intergroup differences, P > 0.05). The perforation rate decreased from 22 to 6% for SE and from 12 to 2% for JE. CUSUM showed proficiency at 59 (SE) and 61 (JE) cases.

In our single-center study, a junior endoscopist reaches similar efficacy to a senior after about 60 cases for proficiency. Performance differs mainly in resection speed, indicating experience improves efficiency not core outcomes. These exploratory findings, derived from a limited sample of two operators, support E-ESD training but are not definitive benchmarks.