OUTCOMES OF ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD) DURING LIVE ENDOSCOPY EVENTS – A 12- YEAR FOLLOW-UP

Aims:

Live endoscopy events (LEE) have increased considerably in the last 20 years. However, ethical and patient-related issues have been raised, especially concerning complications, patient outcome as well as success rate. There is no data showing the outcome of ESD during LEE. In this study, ESD procedures performed during the Augsburg Endo-Update LEE were compared with matched routine procedures.

Methods:

ESDs performed during the Augsburg Endo-Update LEE between 2006 and 2017 were reviewed. The control for each ESD was the next procedure performed outside of the LEE in the same endoscopy unit and matched according to age, location and lesion size. The histological R0 resection rate, procedure time and complication rates were assessed. Complications were defined as a perforation or a bleeding event which led to a re-intervention such as endoscopic therapy or surgery.

Results:

A total of 34 ESD procedures were performed during the Augsburg Endo-Update in the given time period, and were compared with 34 matched routine ESDs. The histological R0 resection rate was significantly higher in the LEE group as compared with the control group (82% vs. 59%; p < 0,05), the complication rate was significantly lower in the LEE group as compared with the control group (6% vs. 23%; p < 0,05) while the procedure time was similar in both groups (133 minutes vs. 130 minutes). However, the difference between both groups leveled out in the second half of the study period (2012 – 2017; R0 94% vs. 72%; complications 5,5% vs. 5,5%) as compared with the first half of the study period (2006 – 2011; R0 69% vs. 44%; complications 2,9% vs. 43%).

Conclusions:

ESD can be performed safely during LEE. The better outcome in the LEE group was probably because most LEE-ESDs were performed by Japanese experts. However, the learning curve of the local European endoscopists improved considerably over time.