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CC BY 4.0 · Endosc Int Open 2023; 11(08): E724-E732
DOI: 10.1055/a-2122-0419
Original article

Predicting procedure duration of colorectal endoscopic submucosal dissection at Western endoscopy centers

Hao Dang 
1   Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, Netherlands (Ringgold ID: RIN4501)
,
Nik Dekkers
1   Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, Netherlands (Ringgold ID: RIN4501)
,
Ewout W. Steyerberg
2   Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands (Ringgold ID: RIN4501)
,
Francisco Baldaque-Silva 
3   Endoscopy Unit, Center for Upper Digestive Diseases, Karolinska Hospital, Stockholm, Sweden (Ringgold ID: RIN59562)
4   Advanced Endoscopy Center Carlos Moreira da Silva, Pedro Hispano Hospital, Matosinhos, Portugal (Ringgold ID: RIN37824)
,
Masami Omae
3   Endoscopy Unit, Center for Upper Digestive Diseases, Karolinska Hospital, Stockholm, Sweden (Ringgold ID: RIN59562)
,
Krijn J.C. Haasnoot 
5   Gastroenterology & Hepatology, University Medical Centre Utrecht, Utrecht, Netherlands (Ringgold ID: RIN8124)
,
Laurelle van Tilburg 
6   Gastroenterology and Hepatology, Erasmus MC, Rotterdam, Netherlands (Ringgold ID: RIN6993)
,
Kate Nobbenhuis
1   Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, Netherlands (Ringgold ID: RIN4501)
,
Jolein van der Kraan
1   Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, Netherlands (Ringgold ID: RIN4501)
,
Alexandra M.J. Langers 
1   Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, Netherlands (Ringgold ID: RIN4501)
,
Jeanin E. van Hooft 
1   Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, Netherlands (Ringgold ID: RIN4501)
,
Wilmar de Graaf
6   Gastroenterology and Hepatology, Erasmus MC, Rotterdam, Netherlands (Ringgold ID: RIN6993)
,
Arjun D. Koch
6   Gastroenterology and Hepatology, Erasmus MC, Rotterdam, Netherlands (Ringgold ID: RIN6993)
,
Paul Didden
7   Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, Netherlands (Ringgold ID: RIN8124)
,
Leon M.G. Moons
7   Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, Netherlands (Ringgold ID: RIN8124)
,
James C.H. Hardwick
1   Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, Netherlands (Ringgold ID: RIN4501)
,
Jurjen J. Boonstra
1   Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, Netherlands (Ringgold ID: RIN4501)
› Author AffiliationsSupported by: Leids Universitair Medisch Centrum 190710
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Correction: Predicting procedure duration of colorectal endoscopic submucosal dissection at Western endoscopy centersEndosc Int Open 2023; 11(08): C5-C5
DOI: 10.1055/a-2150-5897

Abstract

Background and study aims Overcoming logistical obstacles for the implementation of colorectal endoscopic submucosal dissection (ESD) requires accurate prediction of procedure times. We aimed to evaluate existing and new prediction models for ESD duration.

Patients and methods Records of all consecutive patients who underwent single, non-hybrid colorectal ESDs before 2020 at three Dutch centers were reviewed. The performance of an Eastern prediction model [GIE 2021;94(1):133–144] was assessed in the Dutch cohort. A prediction model for procedure duration was built using multivariable linear regression. The model’s performance was validated using internal validation by bootstrap resampling, internal-external cross-validation and external validation in an independent Swedish ESD cohort.

Results A total of 435 colorectal ESDs were analyzed (92% en bloc resections, mean duration 139 minutes, mean tumor size 39 mm). The performance of current unstandardized time scheduling practice was suboptimal (explained variance: R2=27%). We successfully validated the Eastern prediction model for colorectal ESD duration <60 minutes (c-statistic 0.70, 95% CI 0.62–0.77), but this model was limited due to dichotomization of the outcome and a relatively low frequency (14%) of ESDs completed <60 minutes in the Dutch centers. The model was more useful with a dichotomization cut-off of 120 minutes (c-statistic: 0.75; 88% and 17% of “easy” and “very difficult” ESDs completed <120 minutes, respectively). To predict ESD duration as continuous outcome, we developed and validated the six-variable cESD-TIME formula (https://cesdtimeformula.shinyapps.io/calculator/; optimism-corrected R2=61%; R2=66% after recalibration of the slope).

Conclusions We provided two useful tools for predicting colorectal ESD duration at Western centers. Further improvements and validations are encouraged with potential local adaptation to optimize time planning.

Keywords

Polyps / adenomas / ... - Endoscopic resection (polypectomy, ESD, EMRc, ...) - Endoscopy Lower GI Tract - Colorectal cancer - Quality and logistical aspects - Preparation

Supporting information



Publication History

Received: 24 December 2022

Accepted after revision: 27 June 2023

Accepted Manuscript online:
03 July 2023

Article published online:
07 August 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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