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Effectiveness of Strategy-Focused Training in Colorectal Endoscopic Submucosal Dissection: A Retrospective Observational Study

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Abstract

Background

Colorectal ESD, an advanced minimally invasive treatment, presents technical challenges, with globally varying training methods. We analyzed the learning curve of ESD training, emphasizing preoperative strategies, notably gravity traction, to guide ESD instructors and trainee programs.

Method

This retrospective study included 881 cases guided by an experienced supervisor. Six trainees received “strategy-focused” instruction. To evaluate the number of ESD experiences in steps, the following phases were classified based on ESD experiences of each trainees: Phase 0 (0–50 ESD), Phase 1 (51–100 ESD), Phase 2 (101–150 ESD), and Phase 3 (151–200 ESD). Lesion background, outcomes, and safety were compared across phases. Factors contributing to technical difficulty in early (Phase 0 and 1) and late phases (Phase 2 and 3) were identified, along with the utility of traction ESD with device assistance.

Result

Treatment outcomes were favorable, with 99.8% and 94.7% en bloc resection and curative resection rates, respectively. Approximately 90% self-completion rate could be achieved after experiencing about 50 cases (92.7% in Phase 1), signifying proficiency growth despite increased case difficulty. In early phases, factors such as left-sided colon, LST-NG morphology, and severe fibrosis pose challenges. In late phases, LST-NG morphology, mild and severe fibrosis remained significant. Traction-assisted ESD, utilized in 3% of cases, comprised planned (1.1%) and rescue (1.9%) methods. Planned traction aided specific lesions, while rescue traction was common in the right colon.

Conclusion

“Strategy-focused” ESD training consistently yields successful outcomes, effectively adapting to varying difficulty factors in different proficient stages.

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Data availability

No datasets were generated or analysed during the current study.

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Authors and Affiliations

  1. Department of Gastroenterology, Omori Red Cross Hospital, 4-30-1 Chuo, Ota-ku, Tokyo, 143-8527, Japan

    Hideyuki Chiba, Akimichi Hayashi, Yu Ebisawa, Mikio Kobayashi, Jun Arimoto, Hiroki Kuwabara & Michiko Nakaoka

  2. Department of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, 5-9-22 Higashi-Gotanda, Shinagawa-ku, Tokyo, 141-8625, Japan

    Ken Ohata

  3. Ashikari Endoscopy Clinic, 1-12-13 Kamiooka Higashi, Konan-ku, Yokohama, Kanagawa, 233-0001, Japan

    Keiichi Ashikari

  4. Department of Gastroenterology, Hiratsuka City Hospital, 1-19-1 Minamihara, Hiratsuka, Kanagawa, 254-0065, Japan

    Jun Tachikawa

  5. Department of Gastroenterology, Yokohama Rosai Hospital, 3211 Kozukue-cho, Kohoku-ku, Yokohama, Kanagawa, 222-0036, Japan

    Naoya Okada

Authors
  1. Hideyuki Chiba
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  2. Ken Ohata
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  3. Keiichi Ashikari
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  4. Jun Tachikawa
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  6. Akimichi Hayashi
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  7. Yu Ebisawa
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  8. Mikio Kobayashi
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  9. Jun Arimoto
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  10. Hiroki Kuwabara
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  11. Michiko Nakaoka
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Contributions

HC, KA, JT, KO, JA, HK, and MN performed the colorectal ESD. HC recruited the study participants. HC, KA, JT, KO, JA, HK, MN, AH, YE, and MK collected the clinical data of the study participants. Analysis and interpretation of the data was conducted by HC and KO. All the authors have read the final manuscript and approve of its submission for publication.

Corresponding author

Correspondence to Hideyuki Chiba.

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Competing interests

The authors declare no competing interests.

Ethical approval

The study was conducted in accordance with the principles in the Declaration of Helsinki. Informed consent was obtained from all patients prior the procedures. This was also approved by the institutional review board of our hospital (No.23-38).

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Supplementary Information

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Supplementary file1 A two-screen video for ESD learning (MP4 238772 KB)

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Chiba, H., Ohata, K., Ashikari, K. et al. Effectiveness of Strategy-Focused Training in Colorectal Endoscopic Submucosal Dissection: A Retrospective Observational Study. Dig Dis Sci (2024). https://doi.org/10.1007/s10620-024-08430-9

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