Universidade Federal de Minas Gerais, Faculdade de Medicina, Instituto Alfa de Gastroenterologia, Unidade de Endoscopia, Belo Horizonte, MG, Brasil.
Hospital Mater Dei Contorno, Unidade de Endoscopia, Belo Horizonte, MG, Brasil.
Arq Gastroenterol. 2020 Oct-Dec;57(4):477-483. doi: 10.1590/S0004-2803.202000000-84.
Endoscopic submucosal dissection (ESD) enables en bloc excision of superficial neoplasms. Although ESD is widely practiced in Eastern countries like Japan, South Korea and China, its use in the West is supposed to be still limited to few tertiary centers.
This study aimed to investigate the clinical practice of ESD in Brazil by means of an electronic questionnaire elaborated by the Brazilian Society of Digestive Endoscopy (SOBED).
In October 2019, 3512 endoscopist members of SOBED were invited to respond to an electronic survey containing 40 questions divided into four topics: operator profile; clinical experience with ESD; adverse events and training. Informed consent was requested to all participants. The investigators reviewed all responses and considered valid if more than 50% of the questions were answered and additional information, when requested, was provided.
A total of 155 (4.4%) qualified responses entered the study. ESD has been practiced in 22 of 26 Federation States and majority of respondents (32.2%) have 10 to 20 years of practice. ESD has been performed more frequently in private hospitals (101 individuals, 66.9%) and private ambulatory centers (41 individuals, 27.1%). ESD was performed mainly in the stomach (72%), followed by the rectum (57%) and 80% of the individuals reported less than 25 operations. Twenty-four (15.4 %) individuals reported perforation and 4 (2.5%) of them reported postoperative deaths. Approximately a quarter of responders denied hands-on training in models or visit to training centers.
ESD appears to be practiced throughout the country, not only in tertiary or academic institutions and mainly in private practice. Most operators received limited training and still are at the beginning of their learning curve. The reported adverse events and mortality rates appear to be higher than Eastern reports.
内镜黏膜下剥离术（ESD）能够整块切除表浅肿瘤。虽然 ESD 在日本、韩国和中国等东方国家得到广泛应用，但在西方，其应用据说仍局限于少数三级中心。
本研究旨在通过巴西消化内镜学会（SOBED）制定的电子问卷，调查巴西 ESD 的临床实践情况。
2019 年 10 月，向 SOBED 的 3512 名内镜医师成员发出了电子调查问卷，该问卷包含 40 个问题，分为四个主题：术者特征；ESD 临床经验；不良事件和培训。向所有参与者请求了知情同意。调查人员审查了所有回复，认为如果超过 50%的问题得到回答，并提供了额外的信息，则回复有效。
共有 155 份（4.4%）符合条件的回复进入研究。26 个联邦州中有 22 个开展了 ESD，大多数受访者（32.2%）有 10 至 20 年的实践经验。ESD 主要在私立医院（101 人，66.9%）和私立门诊中心（41 人，27.1%）进行。ESD 主要在胃（72%），其次是直肠（57%），80%的受访者报告手术次数少于 25 次。24 名（15.4%）受访者报告穿孔，其中 4 名（2.5%）报告术后死亡。约四分之一的应答者否认在模型上进行过实际操作培训或参观过培训中心。
ESD 似乎在全国范围内开展，不仅在三级或学术机构，而且主要在私人执业中开展。大多数术者接受的培训有限，仍处于学习曲线的早期阶段。报告的不良事件和死亡率似乎高于东方国家的报告。
