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The learning experience for endoscopic submucosal dissection in a non-academic western hospital: a single operator's untutored, prevalence-based approach.
Mavrogenis, Georgios; Ntourakis, Dimitrios; Wang, Zhen; Tsevgas, Ioannis; Zachariadis, Dimitrios; Kokolas, Nikolaos; Kaklamanis, Loukas; Bazerbachi, Fateh.
Affiliation
  • Mavrogenis G; Division of Hybrid Interventional Endoscopy, Department of Gastroenterology, Mediterraneo Hospital, Athens, Greece (Georgios Mavrogenis, Ioannis Tsevgas, Dimitrios Zachariadis).
  • Ntourakis D; Department of Surgery, School of Medicine, European University of Cyprus, Nicosia, Cyprus (Dimitrios Ntourakis).
  • Wang Z; Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA (Zhen Wang).
  • Tsevgas I; Division of Hybrid Interventional Endoscopy, Department of Gastroenterology, Mediterraneo Hospital, Athens, Greece (Georgios Mavrogenis, Ioannis Tsevgas, Dimitrios Zachariadis).
  • Zachariadis D; Division of Hybrid Interventional Endoscopy, Department of Gastroenterology, Mediterraneo Hospital, Athens, Greece (Georgios Mavrogenis, Ioannis Tsevgas, Dimitrios Zachariadis).
  • Kokolas N; Department of Anesthesiology, Mediterraneo Hospital, Athens, Greece (Nikolaos Kokolas).
  • Kaklamanis L; Department of Pathology, Onassis Cardiac Surgery Center, Athens, Greece (Loukas Kaklamanis).
  • Bazerbachi F; CentraCare, St Cloud Hospital, Interventional Endoscopy Program, St Cloud, MN, USA (Fateh Bazerbachi).
Ann Gastroenterol ; 34(6): 836-844, 2021.
Article in En | MEDLINE | ID: mdl-34815650
BACKGROUND: 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. METHODS: 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. RESULTS: Pathology revealed carcinoma (n=14), neuroendocrine tumor (n=7), precancerous lesion (n=27), or other submucosal tumors (n=12). The rates of en bloc and R0 resection were 98% and 91%, respectively. The median resection speed was <3 cm2/h for the first 20 cases, but improved progressively to ≥9 cm2/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. CONCLUSIONS: 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.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Type of study: Prevalence_studies / Risk_factors_studies Language: En Journal: Ann Gastroenterol Year: 2021 Document type: Article Country of publication: Greece

Full text: 1 Collection: 01-internacional Database: MEDLINE Type of study: Prevalence_studies / Risk_factors_studies Language: En Journal: Ann Gastroenterol Year: 2021 Document type: Article Country of publication: Greece