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Real-world learning curve analysis of colorectal endoscopic submucosal dissection: a large multicenter study

  • Kazuki Boda
  • Shiro OkaEmail author
  • Shinji Tanaka
  • Shinji Nagata
  • Masaki Kunihiro
  • Toshio Kuwai
  • Yuko Hiraga
  • Akira Furudoi
  • Koichi Nakadoi
  • Hideharu Okanobu
  • Tomohiro Miwata
  • Shiro Okamoto
  • Kazuaki Chayama
Article
  • 119 Downloads

Abstract

Background

The current status of colorectal endoscopic submucosal dissection (ESD) performed by endoscopists without colorectal ESD experience is unknown. This study evaluated the quality of colorectal ESD performed by endoscopists without colorectal ESD experience.

Methods

We retrospectively examined the outcomes of 420 consecutive patients with 427 superficial colorectal tumors (male/female, 251/169; mean age, 69 years) who underwent ESD. The procedures were performed by 31 endoscopists without colorectal ESD experience using needle knife-type devices at 13 hospitals from October 2008 to June 2017. Cases were divided into the first and second phases according to the experience of the endoscopist: the first phase included the first 20 cases and the second phase included case 21 and beyond. We also identified factors associated with en bloc resection failure.

Results

Rates of colonic tumors, laterally spreading tumors of the non-granular type, poor scope operability, and severe submucosal fibrosis for the first phase were significantly lower than those for the second phase. The en bloc resection rates for the first and second phases were 93% and 96%, respectively. The factors associated with en bloc resection failure were poor scope operability (odds ratio [OR] 2.6; 95% confidence interval [CI] 1.0–6.5), severe submucosal fibrosis (OR 6.5; 95% CI 2.6–15.9), and the first 20 cases (OR 3.4; 95% CI 1.2–10.1).

Conclusion

Inexperienced endoscopists should initially perform colorectal ESD for tumors without severe submucosal fibrosis under good scope operability for at least 20 cases.

Keywords

Learning curve Colorectal ESD Inexperience Endoscopist 

Notes

Compliance with ethical standards

Disclosures

Drs. Kazuki Boda, Shiro Oka, Shinji Tanaka, Shinji Nagata, Masaki Kunihiro, Toshio Kuwai, Yuko Hiraga, Akira Furudoi, Koichi Nakadoi, Hideharu Okanobu, Tomohiro Miwata, Shiro Okamoto, and Kazuaki Chayama have no conflicts of interest or financial ties to disclose.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Kazuki Boda
    • 1
  • Shiro Oka
    • 1
    Email author
  • Shinji Tanaka
    • 2
  • Shinji Nagata
    • 3
  • Masaki Kunihiro
    • 4
  • Toshio Kuwai
    • 5
  • Yuko Hiraga
    • 6
  • Akira Furudoi
    • 7
  • Koichi Nakadoi
    • 8
  • Hideharu Okanobu
    • 9
  • Tomohiro Miwata
    • 10
  • Shiro Okamoto
    • 11
  • Kazuaki Chayama
    • 12
  1. 1.Department of Gastroenterology and MetabolismHiroshima University HospitalHiroshimaJapan
  2. 2.Department of EndoscopyHiroshima University HospitalHiroshimaJapan
  3. 3.Department of GastroenterologyHiroshima City Asa Citizens HospitalHiroshimaJapan
  4. 4.Department of Internal MedicineHiroshima City Hiroshima Citizens HospitalHiroshimaJapan
  5. 5.Department of GastroenterologyNational Hospital Organization Kure Medical Center and Chugoku Cancer CenterHiroshimaJapan
  6. 6.Department of EndoscopyHiroshima Prefectural HospitalHiroshimaJapan
  7. 7.Department of GastroenterologyJA Hiroshima General HospitalHiroshimaJapan
  8. 8.Department of GastroenterologyOnomichi General HospitalHiroshimaJapan
  9. 9.Department of GastroenterologyHiroshima Red Cross Hospital and Atomic-Bomb Survivors HospitalHiroshimaJapan
  10. 10.Department of GastroenterologyChugoku Rosai HospitalHiroshimaJapan
  11. 11.Department of GastroenterologyKure Kyosai HospitalHiroshimaJapan
  12. 12.Department of Gastroenterology and MetabolismHiroshima University HospitalHiroshimaJapan

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