Mavrogenis Georgios, Ntourakis Dimitrios, Wang Zhen, Tsevgas Ioannis, Zachariadis Dimitrios, Kokolas Nikolaos, Kaklamanis Loukas, Bazerbachi Fateh
Division of Hybrid Interventional Endoscopy, Department of Gastroenterology, Mediterraneo Hospital, Athens, Greece (Georgios Mavrogenis, Ioannis Tsevgas, Dimitrios Zachariadis).
Department of Surgery, School of Medicine, European University of Cyprus, Nicosia, Cyprus (Dimitrios Ntourakis).
Ann Gastroenterol. 2021 Nov-Dec;34(6):836-844. doi: 10.20524/aog.2021.0649. Epub 2021 Jul 2.
Studies of learning experience in endoscopic submucosal dissection (ESD) commonly originate from the East. Little is known about the performance of ESD in low-volume western centers. Furthermore, it is unclear whether ESD can be self-taught without a tutored approach.
We performed a retrospective analysis of consecutive ESDs, performed in an untutored prevalence-based fashion by a single operator at a private Greek hospital from 2016-2020. Out of 60 lesions, standard ESD was applied for 54 and enucleation for 6; 41 were mucosal and 19 submucosal; 3 esophageal, 24 gastric, one duodenal, 12 colonic, and 20 rectal.
Pathology revealed carcinoma (n=14), neuroendocrine tumor (n=7), precancerous lesion (n=27), or other submucosal tumors (n=12). The rates of and R0 resection were 98% and 91%, respectively. The median resection speed was <3 cm/h for the first 20 cases, but improved progressively to ≥9 cm/h after 40 cases. Two patients underwent laparoscopic surgery for colonic perforation, and one received a blood transfusion because of delayed bleeding (serious adverse event rate: 5%). No deaths occurred. The median hospital stay was 1.3 days. Variables associated with improvement in ESD speed during the second period of the study were the application of countertraction and the experience acquired through other endosurgical techniques.
ESD was safe and effective in a low-volume center, with an acceptable adverse events rate. At least 40 mixed cases were needed to achieve a high resection speed. Additive experience gained through other endosurgical procedures probably contributed to the improvement in performance.
内镜黏膜下剥离术（ESD）学习经验的研究通常起源于东方。对于西方低手术量中心ESD的开展情况知之甚少。此外，尚不清楚ESD能否在无带教的情况下自学。
我们对2016年至2020年在希腊一家私立医院由一名操作者以基于患病率的无带教方式连续进行的ESD手术进行了回顾性分析。在60个病变中，54个采用标准ESD，6个采用摘除术；41个为黏膜病变，19个为黏膜下病变；3个位于食管，24个位于胃，1个位于十二指肠，12个位于结肠，20个位于直肠。
病理显示为癌（n = 14）、神经内分泌肿瘤（n = 7）、癌前病变（n = 27）或其他黏膜下肿瘤（n = 12）。整块切除率和R0切除率分别为98%和91%。前20例的中位切除速度<3 cm/h，但在40例之后逐渐提高到≥9 cm/h。2例患者因结肠穿孔接受了腹腔镜手术，1例因延迟出血接受了输血（严重不良事件发生率：5%）。无死亡病例。中位住院时间为1.3天。在研究的第二阶段，与ESD速度提高相关的变量是应用反牵引以及通过其他内镜手术技术获得的经验。
ESD在低手术量中心是安全有效的，不良事件发生率可接受。至少需要40例混合病例才能达到高切除速度。通过其他内镜手术获得的附加经验可能有助于提高手术表现。
