Document Detail


Difficulties and outcomes in starting endoscopic submucosal dissection.
MedLine Citation:
PMID:  19911227     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Anthony Yuen Bun Teoh; Philip Wai Yan Chiu; Simon Kin Hung Wong; Joseph Jao Yiu Sung; James Yun Wong Lau; Enders Kwok Wai Ng
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-11-13
Journal Detail:
Title:  Surgical endoscopy     Volume:  24     ISSN:  1432-2218     ISO Abbreviation:  Surg Endosc     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-04-28     Completed Date:  2010-08-17     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8806653     Medline TA:  Surg Endosc     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  1049-54     Citation Subset:  IM    
Affiliation:
Division of Upper Gastrointestinal Surgery, Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, China. anthonyteoh@surgery.cuhk.edu.hk
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MeSH Terms
Descriptor/Qualifier:
Animals
Dissection / education,  methods*
Education, Medical, Continuing / methods*
Endoscopes, Gastrointestinal
Endoscopy, Gastrointestinal / methods*
Esophageal Neoplasms / pathology,  surgery*
Gastroenterology / education*
Humans
Intestinal Mucosa / pathology,  surgery*
Middle Aged
Neoplasm Staging
Prospective Studies
Stomach Neoplasms / pathology,  surgery*
Swine
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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