Affiliation:
1. Gastroenterology, Baylor College of Medicine, Houston, United States
2. Department of Medicine, Baylor College of Medicine, Houston, United States
3. College of Liberal Arts and Social Sciences, University of Houston, Houston, United States
Abstract
Abstract
Background and study aims Endoscopic submucosal dissection (ESD)
allows removal of tumors en-bloc. Western adoption of ESD has been hindered by its steep
learning curve. Western data regarding ESD learning curve are limited. We analyzed the
learning curve of a single endoscopist at a tertiary referral center in the United
States.
Patients and methods All consecutive ESDs performed by a single
endoscopist at a tertiary referral center in the United States from 2015 through 2022 were
identified. Descriptive statistics and CUSUM analysis were used to describe the learning curve
for en-bloc, R0 resection, and resection speed.
Results In our study, 503 patients with 515 lesions were
included. Severe submucosal fibrosis was found in 17% of the lesions. The rates of en-bloc,
R0, and curative resections were 81.9%, 71.1%, and 68.4%, respectively. CUSUM analysis showed
that the learning curve plateaued at 268, 347, and 170 cases for en-bloc resection, R0
resection, and achieving a resection speed > 9 cm2/hr. Fibrosis significantly
affected the R0 resection rate in the regression analysis (95% confidence interval 0.21–0.55).
In colonic ESD curve analysis, the learning plateau was reached after 185 cases for both
en-bloc and R0 resection.
Conclusions Following ex-vivo training in an animal model, an
untutored expert operator achieved competency in ESD between 250 and 350 procedures. Our data
can inform development of future training programs in the West.