Endoscopy 2018; 50(04): S98
DOI: 10.1055/s-0038-1637318
ESGE Days 2018 oral presentations
21.04.2018 – Endoscopic submucosal dissection
Georg Thieme Verlag KG Stuttgart · New York

ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD) BY TRAINEES TUTORED BY EXPERTS: SHORT-TERM RESULTS

A Wagner
1   Dept. of Medicine I, Paracelsus Medical University/Univ. Hospital Salzburg/(SALK), Salzburg, Austria
,
D Neureiter
2   Institute of Pathology, Paracelsus Medical University/Salzburger Landeskliniken (SALK), Salzburg, Austria
,
A Ziachehabi
3   Dept. of Medicine IV, Ordensklinikum Linz, Linz, Austria
,
T Kiesslich
1   Dept. of Medicine I, Paracelsus Medical University/Univ. Hospital Salzburg/(SALK), Salzburg, Austria
,
HP Allgaier
4   Dept. of Medicine, Diakonie Krankenhaus, Freiburg, Germany
,
G Kleber
5   Dept. of Medicine I, Ostalb-Klinikum, Aalen, Germany
,
K Heiler
6   Dept. of Medicine, Div. of Endoscopy, Klinikum Südostbayern, Traunstein, Germany
,
D Plamenig
7   Dept. of Medicine, Landeskrankenhaus, Wolfsberg, Austria
,
P Friesenbicher
8   Dept. of Medicine I, Paracelsus Medical University/Salzburger Landeskliniken (SALK), Salzburg, Austria
9   Dept. Medicine, Landeskrankenhaus, Mürzzuschlag, Austria
,
M Lutz
10   Dept. of Medicine, Gastroenterology, Caritas-Klinikum Saarbrücken, Saarbrücken, Germany
,
H Seifert
11   Dept. of Medicine I, University Hospital Oldenburg, Oldenburg, Germany
,
M Anzinger
12   Dept. of Medicine, Krankenhaus Barmherzige Brüder, München, Germany
,
T Uraoka
13   Dept. of Gastroenterology, Tokyo Medical Center, Tokyo, Japan
,
T Toyonaga
14   Dept. of Endoscopy, Kobe University Hospital, Kobe, Japan
,
N Yahagi
15   Cancer Center, Keio University School of Medicine, Tokyo, Japan
,
T Oyama
16   Dept. of Endoscopy, Saku Central Hospital Advanced Care Center, Saku City, Japan
,
F Berr
17   Dept. Medicine I, Paracelsus Medical University/Salzburger Landeskliniken (SALK), Salzburg, Austria
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

Also available at
 

Aims:

To enhance curative resection rate and learning curve for implementation of ESD technique.

Methods:

Patients (n = 101; 73 [37 – 91] years old) with neoplasias (n = 120; 20 esophageal, 13 gastric, 15 duodenal, 72 colorectal) fulfilling Japanese criteria for en-bloc resection were referred with consent for tutored ESD to Salzburg. European endoscopists – with initial clinical ESD experience – partially or completely resected the lesions under supervision of one of the four Japanese experts in 17 tutoring sessions (each with a duration of 1 – 4 days, 24 active and 27 passive participants from 16 countries).

Results:

ESD intention was diagnostic for 4 submucosa-(sm)-invasive early carcinomas (2 Barrett's, 2 colorectal – ESD R0, but referred for surgery) and curative for 116 lesions. One ESD (recurrent rectal adenoma with extreme sm-fibrosis) was stopped (success rate 99%). Of the remaining 115 resections, 107 were performed as ESD en-bloc (93%). Five colonic LSTs (4%) required ESD-snaring in 2 – 4 particles, and 3 duodenal adenomas (d = 4 – 7 cm with LGIEN) were a priori resected with piece-meal EMR (3%). ESD en-bloc specimens were in 14% margin-positive (R1, LGIEN). However, oncologically curative R0 resections (98% performed en-bloc) were achieved in all 49 malignant and in 6 symptomatic, potentially malignant submucosal tumors. Complications, such as microperforation, bleeding or stenosis, occurred in 14% of cases. All were endoscopically managed without surgery or mortality or long-term morbidity.

Conclusions:

Performance of ESD under tutoring of experts results in safe and curative outcome for the patients and best enhances diagnostic and electrosurgical competence of ESD trainees.