Curriculum for training in endoscopic mucosal resection in the colon: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement

David J. Tate; Maria Eva Argenziano; John Anderson; Pradeep Bhandari; Ivo Boškoski; Marek Bugajski; Lobke Desomer; Steven J. Heitman; Hiroshi Kashida; Vladimir Kriazhov; Ralph R. T. Lee; Ivan Lyutakov; Pedro Pimentel-Nunes; Liseth Rivero-Sánchez; Siwan Thomas-Gibson; Henrik Thorlacius; Michael J. Bourke; Tony C. Tham; Raf Bisschops

doi:10.1055/a-2077-0497

Endoscopy, Inhaltsverzeichnis

Endoscopy 2023; 55(07): 645-679
DOI: 10.1055/a-2077-0497

Position Statement

Curriculum for training in endoscopic mucosal resection in the colon: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement

David J. Tate

¹Department of Gastroenterology and Hepatology, University Hospital of Ghent, Ghent, Belgium

²Faculty of Medicine, University of Ghent, Ghent, Belgium

,

Maria Eva Argenziano

³Clinic of Gastroenterology, Hepatology and Emergency Digestive Endoscopy, Università Politecnica delle Marche, Ancona, Italy

,

John Anderson

⁴Cheltenham General Hospital, Gloucestershire Hospitals Foundation Trust, Cheltenham, UK

,

Pradeep Bhandari

⁵Endoscopy Department, Portsmouth Hospitals University NHS Trust, Portsmouth, UK

,

Ivo Boškoski

⁶Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy

,

Marek Bugajski

⁷Department of Gastroenterology, Luxmed Oncology, Warsaw, Poland

,

Lobke Desomer

⁸AZ Delta Roeselare, University Hospital Ghent, Ghent, Belgium

,

Steven J. Heitman

⁹Division of Gastroenterology and Hepatology, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada

,

Hiroshi Kashida

¹⁰Department of Gastroenterology and Hepatology, Kindai University, Faculty of Medicine, Osaka, Japan

,

Vladimir Kriazhov^*

¹¹Endoscopy Department, Nizhny Novgorod Regional Clinical Oncology Center, Nizhny Novgorod, Russia Federation

,

Ralph R. T. Lee

¹²The Ottawa Hospital - Civic Campus, University of Ottawa, Ottawa, Canada

,

Ivan Lyutakov

¹³University Hospital Tsaritsa Yoanna-ISUL, Medical University Sofia, Sofia, Bulgaria

,

Pedro Pimentel-Nunes

¹⁴Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal

¹⁵Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal

¹⁶Surgery and Physiology Department, Faculty of Medicine of the University of Porto, Porto, Portugal

,

Liseth Rivero-Sánchez

¹⁷Gastroenterology Department, Hospital Clínic de Barcelona, Barcelona, Spain

¹⁸Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBERehd), Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain

,

Siwan Thomas-Gibson

¹⁹St. Mark’s Hospital, London and Imperial College London, London, UK

,

Henrik Thorlacius

²⁰Department of Surgery, Lund University, Malmö, Sweden

,

Michael J. Bourke

²¹Department of Gastroenterology, Westmead Hospital, Sydney, Australia

²²University of Sydney, Sydney, Australia

,

Tony C. Tham

²³Division of Gastroenterology, Ulster Hospital, Dundonald, Belfast, Northern Ireland

,

Raf Bisschops

²⁴Department of Gastroenterology and Hepatology, University Hospitals Leuven, TARGID, KU Leuven, Leuven, Belgium

› Institutsangaben

Abstract

Main recommendations

Endoscopic mucosal resection (EMR) is the standard of care for the complete removal of large (≥ 10 mm) nonpedunculated colorectal polyps (LNPCPs). Increased detection of LNPCPs owing to screening colonoscopy, plus high observed rates of incomplete resection and need for surgery call for a standardized approach to training in EMR.

1 Trainees in EMR should have achieved basic competence in diagnostic colonoscopy, < 10-mm polypectomy, pedunculated polypectomy, and common methods of gastrointestinal endoscopic hemostasis. The role of formal training courses is emphasized. Training may then commence in vivo under the direct supervision of a trainer.

2 Endoscopy units training endoscopists in EMR should have specific processes in place to support and facilitate training.

3 A trained EMR practitioner should have mastered theoretical knowledge including how to assess an LNPCP for risk of submucosal invasion, how to interpret the potential difficulty of a particular EMR procedure, how to decide whether to remove a particular LNPCP en bloc or piecemeal, whether the risks of electrosurgical energy can be avoided for a particular LNPCP, the different devices required for EMR, management of adverse events, and interpretation of reports provided by histopathologists.

4 Trained EMR practitioners should be familiar with the patient consent process for EMR.

5 The development of endoscopic non-technical skills (ENTS) and team interaction are important for trainees in EMR.

6 Differences in recommended technique exist between EMR performed with and without electrosurgical energy. Common to both is a standardized technique based upon dynamic injection, controlled and precise snare placement, safety checks prior to the application of tissue transection (cold snare) or electrosurgical energy (hot snare), and interpretation of the post-EMR resection defect.

7 A trained EMR practitioner must be able to manage adverse events associated with EMR including intraprocedural bleeding and perforation, and post-procedural bleeding. Delayed perforation should be avoided by correct interpretation of the post-EMR defect and treatment of deep mural injury.

8 A trained EMR practitioner must be able to communicate EMR procedural findings to patients and provide them with a plan in case of adverse events after discharge and a follow-up plan.

9 A trained EMR practitioner must be able to detect and interrogate a post-endoscopic resection scar for residual or recurrent adenoma and apply treatment if necessary.

10 Prior to independent practice, a minimum of 30 EMR procedures should be performed, culminating in a trainer-guided assessment of competency using a validated assessment tool, taking account of procedural difficulty (e. g. using the SMSA polyp score).

11 Trained practitioners should log their key performance indicators (KPIs) of polypectomy during independent practice. A guide for target KPIs is provided in this document.

Volltext

Referenzen

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