Dong-Hoon Yang1, Gwi Hong Jeong2, Yerim Song1, Sang Hyoung Park1, Soo-Kyung Park1, Jong Wook Kim1, Kee Wook Jung1, Kyung-Jo Kim1, Byong Duk Ye1, Seung-Jae Myung1, Suk-Kyun Yang1, Jin-Ho Kim1, Young Soo Park3, Jeong-Sik Byeon4. 1. Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea. 2. Department of Internal Medicine, Yeosu Jeil Hospital, Yeosu, South Korea. 3. Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea. 4. Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea. jsbyeon@amc.seoul.kr.
Abstract
BACKGROUND: Experience in gastric endoscopic submucosal dissection (ESD) has been suggested as a prerequisite for performing colorectal ESD by some experts. AIMS: To evaluate the feasibility of performing colorectal ESD without experience in gastric ESD. METHODS: Between November 2009 and December 2013, ESD was attempted for 250 colorectal lesions by an endoscopist having extensive colonoscopy experience but no prior experience of gastric ESD. All attempts were categorized according to the chronological order of procedures: group 1, attempts 1-50; group 2, attempts 51-100; group 3, attempts 101-150; group 4, attempts 151-200; and group 5, attempts 201-250. Procedure-related outcomes were analyzed. RESULTS: En bloc resection rate ≥80% was achieved after initial ten ESD attempts. The ESD success rate (72, 80, 90, 90, and 94% in group 1-5, respectively; p for trend = 0.001), perforation rate (14, 14, 6, 6, and 0% in group 1-5, respectively; p for trend = 0.003), and macroperforation rate (6, 6, 2, 2, and 0% in group 1-5, respectively; p for trend = 0.042) improved as experience accumulated. Performing >100 ESDs, rectal location, and absence of submucosal fibrosis were independent predictors of successful procedure. CONCLUSION: Colorectal ESD can be safely and effectively performed by an endoscopist having extensive experience in colonoscopy-related procedures even without previous experience of gastric ESD. Meticulous case selection for ESD novice and active supervision by expert endoscopists during the initial learning period may minimize the risk of perforation.
BACKGROUND: Experience in gastric endoscopic submucosal dissection (ESD) has been suggested as a prerequisite for performing colorectal ESD by some experts. AIMS: To evaluate the feasibility of performing colorectal ESD without experience in gastric ESD. METHODS: Between November 2009 and December 2013, ESD was attempted for 250 colorectal lesions by an endoscopist having extensive colonoscopy experience but no prior experience of gastric ESD. All attempts were categorized according to the chronological order of procedures: group 1, attempts 1-50; group 2, attempts 51-100; group 3, attempts 101-150; group 4, attempts 151-200; and group 5, attempts 201-250. Procedure-related outcomes were analyzed. RESULTS: En bloc resection rate ≥80% was achieved after initial ten ESD attempts. The ESD success rate (72, 80, 90, 90, and 94% in group 1-5, respectively; p for trend = 0.001), perforation rate (14, 14, 6, 6, and 0% in group 1-5, respectively; p for trend = 0.003), and macroperforation rate (6, 6, 2, 2, and 0% in group 1-5, respectively; p for trend = 0.042) improved as experience accumulated. Performing >100 ESDs, rectal location, and absence of submucosal fibrosis were independent predictors of successful procedure. CONCLUSION:Colorectal ESD can be safely and effectively performed by an endoscopist having extensive experience in colonoscopy-related procedures even without previous experience of gastric ESD. Meticulous case selection for ESD novice and active supervision by expert endoscopists during the initial learning period may minimize the risk of perforation.
Authors: R J Schlemper; R H Riddell; Y Kato; F Borchard; H S Cooper; S M Dawsey; M F Dixon; C M Fenoglio-Preiser; J F Fléjou; K Geboes; T Hattori; T Hirota; M Itabashi; M Iwafuchi; A Iwashita; Y I Kim; T Kirchner; M Klimpfinger; M Koike; G Y Lauwers; K J Lewin; G Oberhuber; F Offner; A B Price; C A Rubio; M Shimizu; T Shimoda; P Sipponen; E Solcia; M Stolte; H Watanabe; H Yamabe Journal: Gut Date: 2000-08 Impact factor: 23.059
Authors: Keun Young Shin; Seong Woo Jeon; Kwang Bum Cho; Kyung Sik Park; Eun Soo Kim; Chang Keun Park; Yun Jin Chung; Joong Goo Kwon; Jin Tae Jung; Eun Young Kim; Kyeong Ok Kim; Byung Ik Jang; Si Hyung Lee; Jeong Bae Park; Chang Hun Yang Journal: Gut Liver Date: 2015-03 Impact factor: 4.519