Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
Dis Colon Rectum. 2011 Oct;54(10):1307-12. doi: 10.1097/DCR.0b013e3182282ab0.
Colorectal endoscopic submucosal dissection requires a high level of skill and experience in therapeutic endoscopy because of the high risk of complications such as perforation and bleeding. Greater understanding of the procedural learning curve is required to standardize training and to achieve wider acceptance of this procedure.
The aims of this study were to evaluate the clinical outcomes of colorectal endoscopic submucosal dissection and to clarify its learning curve for endoscopists.
We retrospectively reviewed the clinical outcomes for consecutive patients with colorectal neoplasms who underwent endoscopic submucosal dissection by 2 trainees under the guidance of experienced specialists.
The study was performed at the National Cancer Center Hospital, Tokyo, Japan.
Colorectal endoscopic submucosal dissections were performed for 101 consecutive patients with 102 colorectal neoplasms between April 2008 and December 2010.
Procedure time, en bloc resection rate, completion rate, and complications were retrospectively compared between 4 training periods in which each trainee performed 10 endoscopic submucosal dissections per period and a final training period in which the trainees performed 10 to 12 endoscopic submucosal dissections to analyze the skill improvement with time.
The procedure time and en bloc resection rate were not significantly different among the training periods. However, the completion rates in the fourth (100%) and fifth (95.5%) training periods (≥ 31 cases/trainee) were significantly higher (P < .001) than those in the first (45%), second (70%), and third (80%) training periods (1-30 cases/trainee). Two cases of perforation occurred during the study.
Limitations include the single-center design. Training programs and instruments vary with institution, which could affect the learning curve.
Trainee endoscopists are able to perform colorectal endoscopic submucosal dissection without serious complications under the guidance of experienced specialists. They can perform it safely and independently after preparatory training and experience with ≥ 30 cases.
由于穿孔和出血等并发症的风险较高，结直肠内镜黏膜下剥离术需要治疗内镜方面的高超技能和丰富经验。为了规范培训并更广泛地接受这种手术，我们需要更好地了解操作学习曲线。
本研究旨在评估结直肠内镜黏膜下剥离术的临床结果，并阐明内镜医生的学习曲线。
我们回顾性分析了 2008 年 4 月至 2010 年 12 月期间在日本国家癌症中心医院由 2 名受训者在经验丰富的专家指导下连续对 101 例结直肠肿瘤患者进行内镜黏膜下剥离术的临床结果。
本研究在日本国家癌症中心医院进行。
对 101 例 102 个结直肠肿瘤患者行内镜黏膜下剥离术。
回顾性比较 4 个培训阶段（每个受训者每个阶段行 10 例内镜黏膜下剥离术）和最后一个培训阶段（受训者行 10 至 12 例内镜黏膜下剥离术）的操作时间、整块切除率、完成率和并发症，以分析随时间推移的技能提高情况。
4 个培训阶段之间的操作时间和整块切除率无显著差异。然而，第 4 （100%）和第 5 （95.5%）培训阶段（≥31 例/受训者）的完成率（≥31 例/受训者）显著高于第 1 （45%）、第 2 （70%）和第 3 （80%）培训阶段（1-30 例/受训者）（P<.001）。研究期间发生 2 例穿孔。
本研究存在局限性，包括单中心设计。培训计划和仪器因机构而异，可能会影响学习曲线。
在经验丰富的专家指导下，受训内镜医生能够进行结直肠内镜黏膜下剥离术，且无严重并发症。经过预备培训和 30 例以上的经验积累，他们能够安全且独立地进行操作。
