Endoscopy 2022; 54(S 01): S128-S129
DOI: 10.1055/s-0042-1744898
Abstracts | ESGE Days 2022
ESGE Days 2022 Digital poster exhibition

PAIRED WORKING COMBINED WITH ON-DEMAND DIRECT EXPERT SUPERVISION ALLOWS A SAFE AND EFFECTIVE IMPLEMENTATION OF RECTAL ENDOSCOPIC SUBMUCOSAL DISSECTION IN A NON-ACADEMIC REFERRAL HOSPITAL

P. Leclercq
1   Clinique Mont Legia – CHC Groupe Santé, Gastroenterology, Liege, Belgium
2   UZ Leuven, Gastroenterology, Leuven, Belgium
,
G. Bastens
1   Clinique Mont Legia – CHC Groupe Santé, Gastroenterology, Liege, Belgium
,
O. Plomteux
1   Clinique Mont Legia – CHC Groupe Santé, Gastroenterology, Liege, Belgium
,
N. Bletard
3   Clinique Mont Legia – CHC Groupe Santé, Pathology, Liege, Belgium
,
P. Demaret
4   Clinique Mont Legia – CHC Groupe Santé, Intensive Care Unit, Liege, Belgium
,
R. Bisschops
2   UZ Leuven, Gastroenterology, Leuven, Belgium
,
V. Lepilliez
5   Hôpital Privé Jean Mermoz, Gastroenterology, Lyon, France
› Author Affiliations
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Aims We evaluated the efficacy and the safety of rectal endoscopic submucosal dissection (ESD) implementation in a non-academic referral hospital performed in operator pairs associated with on-demand direct expert supervision.

Methods This is a retrospective analysis of the 90 first consecutive rectal ESDs performed between 2013 and 2021 in one non-academic referral hospital performed by two operators working in pairs, trained similarly to the current ESGE ESD curriculum.

Operators started rectal ESD as a duo, switching every 30’ during the same procedure. On-demand direct expert supervision was requested when procedure was anticipated to be more complex.

The first half (P1) was compared to the second half of the series (P2). “Supervised” were compared to “unsupervised” procedures.

Endpoints included: rates of en-bloc/R0/curative resection, complications, ESD speed, 3- and 12-months recurrence rate.

Results Data and Results of ESD are detailed in [Table 1].

There is no significant difference in en-bloc/R0/curative resection rates between P1 and P2 or “supervised” and “unsupervised” subgroups.

ESD mean speed slightly increased over time in the “unsupervised” group reaching>9cm2/h (8.5 vs 9.2 cm2/h, p>0.05) without increase in complication rate.

P1 compared to P2 showed lower need of expert supervision with a gradual inversion of supervised/unsupervised ratio over time (66.7% vs 26.7%, p<0.05).

There was no recurrence at 3- and 12-months follow-up when data available (72/90 at 3-mo; 44/90 at 12-mo).

Table 1

n=90

Period 1 (1-45)
2013-18
Supervised
n=30 (66.7%)

Period 1 (1-45)
2013-18
Unsupervised
n=15 (33.3%)

Period 2 (46-90)
2018-21
Supervised
n=12 (26.7%)

Period 2 (46-90)
2018-21
Unsupervised
n=33 (73.3%)

ESD specimen surface, mean (mm2)
ESD specimen great axis, mean (mm)
ESD speed, mean (cm2/h)

1787
50.4
20.2

1281
41.8
8.5

2532
63.1
16.6

1155
38.5
9.2

ESD specimen histopathology
- LGD (44)
- HGD (19)
– Adenocarcinoma
*Tis (13)
*sm1 (4)
*sm2 (7)
*T2 (1)
- NET (2)

11
8
6
0
3
1
1

8
2
2
2
1
0
0

10
1
0
1
0
0
0

15
8
5
1
3
0
1

Resection
- en-bloc (96.7%, overall)
- R0 (84.4%, overall)
- Curative (80%, overall)

29 (96.7%)
23 (76.7%)
22 (73.3%)

14 (93.3%)
12 (80%)
12 (80%)

12 (100%)
11 (91.7%)
11 (91.7%)

32 (97%)
30 (90.9%)
28 (84.8%)

Complications
- Bleeding (3%)
- Perforation (2%)
- Stenosis (1%)

2
0
0

1
1
0

0
1
1

0
0
0

Conclusions Working in pairs combined with on-demand direct expert supervision allows effective implementation of rectal ESD in a non-academic referral center with safe gradual transition to autonomy.

Zoom Image
Fig. 1


Publication History

Article published online:
14 April 2022

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