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

机译：结直肠内窥镜黏膜下剥离的真实世界学习曲线分析：一项大型多中心研究

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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.
机译：背景 由没有结直肠 ESD 经验的内窥镜医师进行的结直肠内窥镜粘膜下剥离术 （ESD） 的现状尚不清楚。本研究评估了没有结直肠 ESD 经验的内窥镜医师进行的结直肠 ESD 质量。方法 回顾性分析420例连续427例浅表性结直肠肿瘤患者（男/女，251/169;平均年龄，69岁）接受ESD的结局。2008 年 10 月至 2017 年 6 月，31 名没有结直肠 ESD 经验的内窥镜医生在 13 家医院使用针刀式装置进行了手术。根据内窥镜医师的经验，病例分为第一阶段和第二阶段：第一阶段包括前20例，第二阶段包括21例及以后的病例。我们还确定了与整块切除失败相关的因素。结果 一期结肠肿瘤、非颗粒型肿瘤外侧扩散、内窥镜可操作性差、黏膜下纤维化严重发生率均显著低于二期。第一阶段和第二阶段的整体切除率分别为93%和96%。与整块切除失败相关的因素包括范围可操作性差（比值比 [OR] 2.6;95% 置信区间 [CI] 1.0-6.5）、严重黏膜下纤维化（OR 6.5;95% CI 2.6-15.9）和前 20 例（OR 3.4;95% CI 1.2-10.1）。结论 无经验的内镜医师应首先对无严重黏膜下纤维化的肿瘤进行结直肠ESD，且手术性较好，至少20例。

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