Ebigbo Alanna, Probst Andreas, Römmele Christoph, Messmann Helmut
Department of Gastroenterology, Klinikum Augsburg.
Endosc Int Open. 2018 May;6(5):E524-E530. doi: 10.1055/a-0584-6457. Epub 2018 Apr 18.
The endoscopic submucosal dissection (ESD) of cancerous and precancerous lesions in the gastrointestinal (GI) tract is an effective but difficult-to-learn procedure, especially for Western endoscopists. We developed a step-up training protocol and evaluated its outcome on a single endoscopist using specific performance measures.
The training protocol included a 12-month period of 50 observational and supervised ESD cases as well as 24 animal procedures. After completion of the protocol, ESD competency was evaluated in the first 30 independent ESD cases. Majority of lesions were located in the stomach and rectum. Performance measures included R0-resection rate, complication rate and resection speed.
R0 resection rate was 93 %, complication rate was 7 % and median resection speed was 6,77 cm /h. 1 case of delayed perforation with subsequent hemicolectomy occurred in the descending colon.
The ESD step-up training protocol used in this study on a single endoscopist showed excellent outcomes for lesions in the rectum and stomach. However, ESD training in the upper colon remains a challenge.
胃肠道癌性和癌前病变的内镜黏膜下剥离术（ESD）是一种有效的但难以掌握的手术，尤其对于西方内镜医师而言。我们制定了一个逐步递进的培训方案，并使用特定的性能指标评估了其在一名内镜医师身上的效果。
培训方案包括为期12个月的50例观察性和指导性ESD病例以及24例动物手术。方案完成后，在最初的30例独立ESD病例中评估ESD操作能力。大多数病变位于胃和直肠。性能指标包括R0切除率、并发症发生率和切除速度。
R0切除率为93%，并发症发生率为7%，中位切除速度为6.77 cm²/h。降结肠发生1例延迟穿孔并随后进行了半结肠切除术。
本研究中在一名内镜医师身上使用的ESD逐步递进培训方案对直肠和胃病变显示出了优异的效果。然而，结肠上段的ESD培训仍然是一项挑战。
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