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Difficulties and outcomes in starting endoscopic submucosal dissection

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Abstract

Background

Endoscopic submucosal dissection (ESD) is a technically demanding procedure associated with a higher risk of complications. This study aimed to assess the difficulties and outcomes experienced by endoscopists beginning to perform ESD.

Methods

This prospective study investigated course participants in an ESD training workshop. The participants were asked at the end of the workshop about the ease of using various ESD knives, the occurrence of complications and their management, the procedural time, and the outcomes for the swine used for the procedure.

Results

For this study, 24 endoscopists were trained in performing gastric and esophageal ESD techniques using a porcine model. The mean size of the specimen retrieved was 2.66 ± 1.18 cm. The mean procedural times were 52.09 ± 24.67 min for gastric ESD and 32.50 ± 8.45 min for esophageal ESD. During gastric ESD, 15 participants (65.22%) encountered perforations, whereas bleeding occurred during 13 ESDs (56.52%). There were two procedure-related mortalities. Significantly, a higher proportion of perforations were encountered with the use of noninsulated knives. The perforated and nonperforated groups did not show a difference in prior endoscopic experience (P = 0.335). The majority of the participants agreed that the swine model is appropriate for simulating both human gastric (96%) and esophageal (96%) ESD.

Conclusions

The ESD procedure is technically challenging and associated with a high rate of complications for beginners. The use of noninsulated knives may increase the risk of perforations during the learning curve for gastric ESD, and future prospective trials must evaluate their use. The development of training models may augment the acquisition of skills in low-volume centers but will not replace a standardized patient-based training program.

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Acknowledgments

We express our deepest appreciation for all the overseas faculties from Japan involved in organizing the ESD workshop including Professor Haruhiro Inoue, Digestive Disease Centre, Showa University; Dr. Takuji Gotoda, National Cancer Center Hospital; Dr Noriya Uedo, Osaka Medical Center for Cancer and Cardiovascular Diseases; and Dr. Naohisa Yahagi, Toranomon Hospital. We also thank Olympus Co. Ltd., Hong Kong, and Olympus Tokyo, Japan, for sponsoring the training workshop.

Disclosures

Anthony Y. B. Teoh, Philip W. Y. Chiu, Simon K. H. Wong, Joseph J. Y. Sung, James Y. W. Lau, and Enders K. W. Ng have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Division of Upper Gastrointestinal Surgery, Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, China

    Anthony Yuen Bun Teoh, Philip Wai Yan Chiu, Simon Kin Hung Wong & Enders Kwok Wai Ng

  2. CUHK Jockey Club Minimally Invasive Surgical Skills Centre, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, China

    Enders Kwok Wai Ng

  3. Institute of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China

    Philip Wai Yan Chiu, Joseph Jao Yiu Sung, James Yun Wong Lau & Enders Kwok Wai Ng

Authors
  1. Anthony Yuen Bun Teoh
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  2. Philip Wai Yan Chiu
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  3. Simon Kin Hung Wong
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  4. Joseph Jao Yiu Sung
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  5. James Yun Wong Lau
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  6. Enders Kwok Wai Ng
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Corresponding author

Correspondence to Enders Kwok Wai Ng.

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Teoh, A.Y.B., Chiu, P.W.Y., Wong, S.K.H. et al. Difficulties and outcomes in starting endoscopic submucosal dissection. Surg Endosc 24, 1049–1054 (2010). https://doi.org/10.1007/s00464-009-0724-8

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  • DOI: https://doi.org/10.1007/s00464-009-0724-8

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