Roberta Maselli1, Federico Iacopini2, Francesco Azzolini3, Lucio Petruzziello4, Mauro Manno5, Luca De Luca6, Paolo Cecinato7, Giancarla Fiori8, Teresa Staiano9, Erik Rosa Rizzotto10, Stefano Angeletti11, Angelo Caruso12, Franco Coppola13, Gianluca Andrisani14, Edi Viale3, Guido Missale15, Alba Panarese16, Alessandro Mazzocchi17, Paola Cesaro18, Mariachiara Campanale4, Pietro Occhipinti19, Ottaviano Tarantino20, Cristiano Crosta8, Piero Brosolo21, Sandro Sferrazza22, Emanuele Rondonotti23, Arnaldo Amato23, Lorenzo Fuccio24, Guido Costamagna25, Alessandro Repici26. 1. Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Humanitas University, Milan, Italy. Electronic address: roberta.maselli@humanitas.it. 2. Gastroenterology Endoscopy Unit, S. Giuseppe Hospital, Rome, Italy. 3. Division of Gastroenterology & G.I. Endoscopy, Vita Salute San Raffaele University, Milan, Italy. 4. Digestive Endoscopy Unit, Division of Gastroenterology Fondazione A. Gemelli-Università Cattolica del Sacro Cuore Hospital, IRCCS, Rome, Italy. 5. Digestive Endoscopy Unit, USL Modena, Carpi Hospital, Italy. 6. Division of Gastroenterology & G.I. Endoscopy, Ospedali Riuniti Marche Nord Hospital, Pesaro, Italy. 7. Unit of Gastroenterology and Digestive Endoscopy, USL-IRCCS Reggio Emilia Hospital, Reggio Emilia,Italy. 8. IEO, Digestive Endoscopy Unit, Istituto Europeo di Oncologia IRCCS Hospital, Milano, Italy. 9. Digestive Endoscopy Unit, FPO-IRCCS Candiolo Cancer Institute, Candiolo, TO, Italy. 10. Division of Gastroenterology & G.I. Endoscopy, S. Antonio Hospital, Padova, Italy. 11. Digestive Endoscopy Unit, Sant'Andrea Hospital, a Sapienza university, Roma, Italy. 12. Division of Gastroenterology & G.I. Endoscopy, Baggiovara Hospital, AOU di Modena, Italy. 13. Digestive Endoscopy Unit, Division of Gastroenterology, ASLTO4, Turin, Italy. 14. Digestive Endoscopy Unit, Campus Biomedico Hospital, Rome, Italy. 15. Digestive Endoscopy Unit, ASST Spedali Civili, Brescia University, Italy. 16. Department of Gastroenterology and Digestive Endoscopy, National Research Institute specialized in Gastroenterology ¨S. De Bellis¨ , Castellana Grotte, BA, Italy. 17. Gastroenterology Endoscopy Unit, San Giovanni Battista Hospital, San Giovanni battista, Italy. 18. Endoscopy Unit, Fondazione Poliambulanza, Brescia, Italy. 19. Division of Gastroenterology, ¨ Maggiore della CaritਠHospital and University, Novara, Italy. 20. Division of Gastroenterology & G.I. Endoscopy, San Giuseppe Hospital, ASL Toscana centro, Empoli, Italy. 21. Division of Gastroenterology, Hospital of Pordenone, Pordenone, Italy. 22. Gastroenterology and Endoscopy Unit, Santa Chiara Hospital, APSS, Trento, Italy. 23. Gastroenterology and Digestive Endoscopy Unit, Valduce Hospital, Como, Italy. 24. Department of Medical and Surgical Sciences, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. 25. Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy; Cattolica del Sacro CuoreUniversity, Centre for Endoscopic Research Therapeutics and Training CERTT, Roma, Italy; Université de Strasbourg Institut d'Etudes Avancées USIAS, Strasbourg, France. 26. Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Humanitas University, Milan, Italy; Humanitas University, Department of Biomedical Science, Milan, Italy.
Abstract
BACKGROUND AND AIMS: Most of the evidence supporting endoscopic submucosal dissection (ESD) comes from Asia. European data are primarily reported by specialized referral centers and thus may not be representative of common European ESD practice. The aim of this study is to understand the current state of ESD practice across Italian endoscopy centers. METHODS: All Italian endoscopists who were known to perform ESD were invited to complete a structured questionnaire including: operator features and competencies, ESD training details and clinical outcomes over a 2-year period. RESULTS: Twenty-nine operators from 23 centers (69% response rate) completed the questionnaire: 18 (62%) were <50 years old; 7 (24%) were female; 16 (70%) were located in Northern Italy. Overall ESD volume was <40 cases in 9 (31%) operators, 40-80 in 8 (27.5%), 80-150 in 4 (13.8%) and >150 in 8 (27.5%). Colorectal ESD was predominant for operators with an experience >80 cases. En-bloc resection rates ranged from 77.2 to 97.2% depending on the anatomic location with an R0 resection rate range of 75.3-93.6%. ESD perforation rates in the colon and rectum were significantly lower when experience was >150 compared to 80-150 cases (p < 0.0001 and p = 0.006 for colon and rectum, respectively). CONCLUSION: ESD in Italy is performed by a significant number of operators. Overall, Italian endoscopists performing ESD have achieved a good competence level. However, there is much variability in training protocols, initial supervision of procedures, practice settings, case mix and procedural volume/year that are likely responsible for some of the suboptimal resectional outcomes and increased perforation risk, mainly in the colon. Standardized training programs, practice parameters and auditing of outcomes are required.
BACKGROUND AND AIMS: Most of the evidence supporting endoscopic submucosal dissection (ESD) comes from Asia. European data are primarily reported by specialized referral centers and thus may not be representative of common European ESD practice. The aim of this study is to understand the current state of ESD practice across Italian endoscopy centers. METHODS: All Italian endoscopists who were known to perform ESD were invited to complete a structured questionnaire including: operator features and competencies, ESD training details and clinical outcomes over a 2-year period. RESULTS: Twenty-nine operators from 23 centers (69% response rate) completed the questionnaire: 18 (62%) were <50 years old; 7 (24%) were female; 16 (70%) were located in Northern Italy. Overall ESD volume was <40 cases in 9 (31%) operators, 40-80 in 8 (27.5%), 80-150 in 4 (13.8%) and >150 in 8 (27.5%). Colorectal ESD was predominant for operators with an experience >80 cases. En-bloc resection rates ranged from 77.2 to 97.2% depending on the anatomic location with an R0 resection rate range of 75.3-93.6%. ESD perforation rates in the colon and rectum were significantly lower when experience was >150 compared to 80-150 cases (p < 0.0001 and p = 0.006 for colon and rectum, respectively). CONCLUSION: ESD in Italy is performed by a significant number of operators. Overall, Italian endoscopists performing ESD have achieved a good competence level. However, there is much variability in training protocols, initial supervision of procedures, practice settings, case mix and procedural volume/year that are likely responsible for some of the suboptimal resectional outcomes and increased perforation risk, mainly in the colon. Standardized training programs, practice parameters and auditing of outcomes are required.