CC BY-NC-ND 4.0 · Endosc Int Open 2020; 08(03): E346-E353
DOI: 10.1055/a-1107-2711
Original article

Impact of observational training on endoscopic mucosal resection outcomes and competency for large colorectal polyps: single endoscopist experience

Jeffrey K. Lee*
1  Department of Gastroenterology, Kaiser Permanente San Francisco Medical Center, San Francisco, California, United States
2  Kaiser Permanente Division of Research, Oakland, California, United States
5  Division of Gastroenterology, University of California, San Francisco, San Francisco, California, United States
,
Trilokesh D. Kidambi*
3  Division of Gastroenterology, City of Hope National Medical Center, Duarte, California, United States
,
Tonya Kaltenbach
4  San Francisco Veterans Affairs Healthcare System, San Francisco, California, United States
5  Division of Gastroenterology, University of California, San Francisco, San Francisco, California, United States
,
Yasser M. Bhat
6  Division of Gastroenterology, Palo Alto Medical Foundation, Palo Alto, California, United States
,
Amandeep Shergill
4  San Francisco Veterans Affairs Healthcare System, San Francisco, California, United States
5  Division of Gastroenterology, University of California, San Francisco, San Francisco, California, United States
,
Kenneth R. McQuaid
4  San Francisco Veterans Affairs Healthcare System, San Francisco, California, United States
5  Division of Gastroenterology, University of California, San Francisco, San Francisco, California, United States
,
Jonathan P. Terdiman
5  Division of Gastroenterology, University of California, San Francisco, San Francisco, California, United States
,
Roy M. Soetikno
4  San Francisco Veterans Affairs Healthcare System, San Francisco, California, United States
7  Advanced Gastrointestinal Endoscopy, Mountain View, California, United States
› Author Affiliations

Abstract

Background and study aims Endoscopic mucosal resection (EMR) is standard treatment for large colorectal polyps. However, it is a specialized technique with limited data on the effectiveness of training methods to acquire this skill. The aim of this study was to evaluate the impact of observational training on EMR outcomes and competency in an early-stage endoscopist.

Patients and methods A single endoscopist completed comprehensive EMR training, which included knowledge acquisition and direct observation of EMR cases, and proctored supervision, during the third year of gastroenterology fellowship. After training, EMR was independently attempted on 142 consecutive, large (i. e., ≥ 20 mm), non-pedunculated colorectal polyps between July 2014 and December 2017 (mean age 61.7 years; mean polyp size 30.4 mm; en-bloc resection 55 %). Surveillance colonoscopy for evaluation of residual neoplasia was available for 86 % of the cases. Three primary outcomes were evaluated: endoscopic assessment of complete resection, rate of adverse events (AEs), and rate of residual neoplasia on surveillance colonoscopy.

Results Complete endoscopic resection was achieved in 93 % of cases, the rates of AEs and residual neoplasia were 7.8 % and 7.3 %, respectively. The rate of complete resection remained stable (at 85 % or greater) with increasing experience while rates of AEs and residual neoplasia peaked and decreased after 60 cases.

Conclusions An early-stage endoscopist can acquire the skills to perform effective EMR after completing observational training. At least 60 independent EMRs for large colorectal polyps were required to achieve a plateau for clinically meaningful outcomes.

* Drs. Lee and Kidambi: These authors contributed equally.


Supplementary material



Publication History

Received: 25 June 2019

Accepted: 02 December 2019

Publication Date:
21 February 2020 (online)

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