Korean J Gastroenterol.  2014 Oct;64(4):198-205. 10.4166/kjg.2014.64.4.198.

Chronological Outcomes and Learning Curve of Endoscopic Submucosal Dissection for Colorectal Tumors

• Lee SM
• Kim ES
• Park KS
• Cho KB
• Kim DC
• Kang YJ
• Lee YJ
• Lee JM
• Choi ES
• Choi JH
• Lee HY

• KMID: 1979204
• DOI: http://doi.org/10.4166/kjg.2014.64.4.198

Abstract

BACKGROUND/AIMS
Endoscopic submucosal dissection (ESD) is an effective procedure for en-bloc curative resection of the colorectal tumor. As it requires high technical skills and experience in therapeutic endoscopy, it is important to understand learning curve of ESD technique. The aim of this study was to retrospectively describe the clinical results of ESD and to evaluate learning curve for the ESD of colorectal tumors.
METHODS
A total of 90 patients with 90 colorectal neoplasms, who had undergone ESD at a tertiary referral hospital from July 2009 to December 2012, were enrolled. The ESD was performed by a single endoscopist. All ESD cases were divided into three periods: first, cases 1-30; second, cases 31-60; and third, cases 61-90.
RESULTS
The en-bloc resection rates in third period (100%) was significantly higher than that of the first (93.3%) and second period (80%) (p=0.025). The perforation rate in third period (0%) also significantly decreased compared with that of the first (13.3%) and second period (20%) (p=0.032). To calibrate the difference of tumor size among periods, proficiency was calculated, as the procedure time per specimen area (min/cm2). The proficiency in third period (4.3) was significantly shorter than that of the first (16.8) and second period (10.2) (p=0.004).
CONCLUSIONS
The learning curve of colorectal ESD in our study shows that at least 60 cases of ESD have to be conducted to acquire sufficient skill of degree without perforation.

Keyword

Learning curve; Colon; Endoscopy; Dissection

MeSH Terms

Colon
Colorectal Neoplasms*
Endoscopy
Humans
Learning Curve*
Retrospective Studies
Tertiary Care Centers

Figure

• 

  Fig. 1. Learning curve of procedure time per specimen area (min/cm2). The values represent mean proficiency in each period.

Reference

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