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

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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.

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Author information

Authors and Affiliations

  1. Department of Gastroenterology and Metabolism, Hiroshima University Hospital, 1-2-3 Kasumi Minami-ku, Hiroshima, Japan

    Kazuki Boda & Shiro Oka

  2. Department of Endoscopy, Hiroshima University Hospital, 1-2-3 Kasumi Minami-ku, Hiroshima, Japan

    Shinji Tanaka

  3. Department of Gastroenterology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan

    Shinji Nagata

  4. Department of Internal Medicine, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan

    Masaki Kunihiro

  5. Department of Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Hiroshima, Japan

    Toshio Kuwai

  6. Department of Endoscopy, Hiroshima Prefectural Hospital, Hiroshima, Japan

    Yuko Hiraga

  7. Department of Gastroenterology, JA Hiroshima General Hospital, Hiroshima, Japan

    Akira Furudoi

  8. Department of Gastroenterology, Onomichi General Hospital, Hiroshima, Japan

    Koichi Nakadoi

  9. Department of Gastroenterology, Hiroshima Red Cross Hospital and Atomic-Bomb Survivors Hospital, Hiroshima, Japan

    Hideharu Okanobu

  10. Department of Gastroenterology, Chugoku Rosai Hospital, Hiroshima, Japan

    Tomohiro Miwata

  11. Department of Gastroenterology, Kure Kyosai Hospital, Hiroshima, Japan

    Shiro Okamoto

  12. Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan

    Kazuaki Chayama

Authors
  1. Kazuki Boda
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  2. Shiro Oka
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  3. Shinji Tanaka
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  8. Akira Furudoi
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Corresponding author

Correspondence to Shiro Oka.

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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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Boda, K., Oka, S., Tanaka, S. et al. Real-world learning curve analysis of colorectal endoscopic submucosal dissection: a large multicenter study. Surg Endosc 34, 3344–3351 (2020). https://doi.org/10.1007/s00464-019-07104-2

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