ESD CURRICULUM IN FRANCE: A COMPARATIVE STUDY OF LEARNING CURVES IN 3 FRENCH CENTERS WITH DIFFERENT TRAINING METHODS

Aims Development of ESD in Europe remains limited compared to Japan. ESGE lately published a position statement for the training in ESD. We aimed to compare the learning curves of three french centers, with different curriculum.

Methods We prospectively included 450 patients to analyse the learning curves of the 150 first ESD of three centers: a center with two operators trained independently on animal model only (A), a center with a single operator trained on animal model with exchanges with french experts (B) and a center with a single operator with a one-year fellowship in an european expert center and animal model (C). The primary endpoint was the curative resection rate. Secondary endpoints were the monobloc resection rate, the size of lesions, the speed of resection, the complication rate and the location.

Results Monobloc resection rates were 96,0%(A), 91,3%(B) and 94%(C), histological complete resection rates were 79,3%(A), 77,3%(B) and 81,8%(C) and curative resection rates were 73,3%(A), 73,3%(B) and 73,4%(C) without any significant difference.

All centers experienced significantly increased curative resection rate after the 75th case (77,8% vs 68,9%, p=0,034).

Perforation rates were 8,0%(A), 2,7%(B) and 7,5%(C).

The size of lesions increased with experience (1507mm2 before 75 cases vs 1904mm2 after 75 cases, p< 0,0001) whereas the length of procedures decreased (126,3min vs 90,7min, p=0,036).

Location of lesions waq different with more colonic lesions for centers B and C, more recently trained.

Centers B and C more often used double-clip and rubber band countertraction than center A (respectively 63,3%, 67,7% and 25,33%, p< 0,0001) and performed more colonic ESD (57,3%(B), 38,0%(C) vs 19,3%(A), p< 0,0001).

The average time to perform 30 ESD was 247 days, decreasing over time.

Conclusions Training in ESD is possible in Europe with curative resection rates close to Japanese studies, and seems faster for recently trained centers, maybe thanks to countertraction.