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Endoscopic Submucosal Dissection Facilitating Techniques Among Non-experts: A Systematic Literature Review

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Abstract

Background and Aims

The dissemination of endoscopic submucosal dissection (ESD) has been limited by its technical complexity and safety profile, particularly among non-experts. Various techniques and devices have facilitated the performance of ESD, but their yield and role in the path to learning ESD remain unclear.

Methods

We performed a systematic review by querying MEDLINE, EMBASE, Web of Science, and Japan Medical Abstracts Society specifically for comparative studies investigating the impact of assigned ESD techniques vs. conventional techniques among non-experts in ESD (< 50 ESD procedures). Procedural outcomes of efficacy, efficiency, and safety were assessed.

Results

We identified 46 studies evaluating 54 cohorts in which a total 237 non-experts performed 2461 ESDs conventionally, and 1953 ESDs using an assigned ESD technique (knives, countertraction, miscellaneous techniques). The majority of studies were from East Asia (67%), single-center (96%), observational in design (61%), in an animal model (57%), and gastric location (63%). The most studied techniques were countertraction techniques (48% cohorts) and scissor knives (15% cohorts), both of which commonly enhanced efficiency of ESD, and less so efficacy or safety. Techniques found to be beneficial in experts were more likely to be beneficial in non-experts (70% concordance) than vice versa (47% concordance).

Conclusion

Based on the currently available literature, countertraction techniques and scissor knives should be considered for early incorporation into ESD training by non-experts. Several aspects of ESD training remain understudied, including techniques in Western non-experts, educational resources, and several commonly cited techniques. These areas should guide future investigation to enhance the pathway to learning ESD.

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Abbreviations

ESD:

Endoscopic submucosal dissection

EMR:

Endoscopic mucosal resection

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analysis

JAMAS:

Japan Medical Abstracts Society

RCT:

Randomized controlled trial

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Acknowledgments

The authors thank Lisa Liang Philpotts, Medical Librarian at Massachusetts General Hospital, for her expert assistance in conducting the literature search for this systematic review.

Funding

No sources of funding or grant sources to disclose.

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Authors and Affiliations

  1. Division of Digestive and Liver Diseases, Columbia University Irving Medical Center-New York Presbyterian Hospital, 161 Fort Washington Ave, 8th Fl, Ste 852A, New York, NY, 10032, USA

    Kavel Visrodia, John Poneros & Amrita Sethi

  2. Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan

    Akira Dobashi

  3. CentraCare, Interventional Endoscopy Program, St Cloud Hospital, St Cloud, MN, USA

    Fateh Bazerbachi

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  1. Kavel Visrodia
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  2. Akira Dobashi
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  3. Fateh Bazerbachi
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  4. John Poneros
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Contributions

Conception and design: KV, AD, FB. Analysis and interpretation of the data: KV, AD, FB. Drafting of the article: KV, AD, FB. Critical revision of the article for important intellectual content: KV, AD, FB, JP, AS. Final approval of the article: KV, AD, FB, JP, AS.

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Correspondence to Kavel Visrodia.

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Visrodia, K., Dobashi, A., Bazerbachi, F. et al. Endoscopic Submucosal Dissection Facilitating Techniques Among Non-experts: A Systematic Literature Review. Dig Dis Sci 68, 2561–2584 (2023). https://doi.org/10.1007/s10620-022-07784-2

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