Learning Curve for Gastric Endoscopic Submucosal Dissection – Where are we?

Aims Endoscopic submucosal dissection (ESD) is a technique for the resection of early malignant gastric lesions under implementation in Western countries. This study intends to characterize the learning curve for this technique to facilitate the development of training programs.

Methods Data were collected from all patients referred to ESD for resection of dysplastic or early malignant gastric lesions in a tertiary center, from May 2012 to August 2020. All procedures were performed by the same endoscopist and the expanded criteria were used to define endoscopic cure. Procedures were divided chronologically in 3 groups (n = 96 per group). The occurrence of complications and outcomes of resection were compared between groups with Qui-square and Kruskal-Wallis tests.

Results Two hundred and eighty eight ESDs were performed in 260 patients over 98 months. One hundred fifty-eight patients were male, with an average age of 68.79±9.89. It was observed a superior average age in group 3 (p=0.037), yet there were no differences between groups regarding sex, hypocoagulation/anti-aggregation, comorbidities, and histologic grading of the lesions. The most significant ESD complications were post-procedure bleeding (n = 18; 6.25 %), and intra-procedure perforation (n = 2; 0.69 %), with successful endoscopic treatment in all patients. Bleeding was significatively less frequent in group 3 (p=0.034), and there were no differences in perforation over time. The length of hospital stay after the procedure was significatively lower in group 3 compared with group 1 (p=0.002). There were no significative differences between groups in the proportion of cure (84.62 %), and R0 resection (87.50 %).

Conclusions In this cohort of gastric ESD it was observed a safe and adequate resection of lesions from an initial stage of implementation of the technique. It were necessary 190 procedures to achieve proficiency in the technique with reduction of post-procedure bleeding.

Citation: Silva Mendes S, Ferreira A, Costa R et al. eP187 LEARNING CURVE FOR GASTRIC ENDOSCOPIC SUBMUCOSAL DISSECTION – WHERE ARE WE?. Endoscopy 2021; 53: S158.

Publication History

Article published online:
19 March 2021