PRELIMINARY RESULTS OF “MENTOR-ASSISTED” ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD) TRAINING IN AN EUROPEAN CENTER: LEARNING CURVE AND CLINICAL OUTCOMES

Aims:

Endoscopic Submucosal Dissection allows “en bloc” resection of early gastric cancer. In Western countries ESD procedures are still marginal and performed in few, highly specialized endoscopic centers due to long learning curve, long operating times and high complication rates. The aim of this study is to evaluate the learning curve and clinical outcomes of the first phase of a “novice” endoscopist ESD training with a Japanese mentor- assisted approach in an European Center

Methods:

This case series study was performed in an Italian cancer referral center. One “novice” endoscopist, who had already learned basic procedures, performed ESD under supervision of a Japanese mentor for 15 consecutive superficial gastric lesions. All procedures were analyzed. The procedure was divided into

(a) mucosal incision and

(b) submucosal dissection by completion of the circunferential cut.

“En Bloc resection rate, “complete en bloc” resection rate (R0), complications were evaluated as outcomes. Learning curve was assessed considering self -completion, operation time and reason for supervisor intervention.

Results:

Between October 2016 and October 2017, 15 gastric ESDs were performed. Mean lesion diameter was 24.46 mm. 9/15 lesions were early gastric cancer and 6 lesions were intraepithelial neoplasia with high grade displasia. All 15 lesions were resected “en bloc” (100%). There was a good overall “complete en bloc “ R0 resection rate of 93% (14/15) a complication rate of 6% (one delayed hemorrage in one patient). Mean resection time calculated as min/cm² (time divided for piece resected area) was 12.9 ± 7.4 min/cm². Operating time shows a progressive reduction. All procedures were self-completed, in two cases we had a supervisor intervention. These results was similar to first phase of japanese training series.

Conclusions:

These preliminary results show that ESD training with japanese mentor-assisted approach for “novice “ endoscopists in Western countries is safe and feasible.