Tsuneo Oyama, Naohisa Yahagi, Thierry Ponchon, Tobias Kiesslich, Andrej Wagner, Takashi Toyonaga, Toshio Uraoka, Akiko Takahashi, Alexander Ziachehabi, Daniel Neureiter, Maria Fuschlberger, Franz Schachinger, Hans Seifert, Georg Kaehler, Alexandr Mitrakov, Sergey V. Kantsevoy, Helmut Messmann, Juergen Hochberger, Frieder Berr
- Background and aims
Transfer of ESD technique for early gastrointestinal cancer from Japan requires expert-supervised experimental training before unsupervised implementation of clinical ESD.
Aims
To evaluate unsupervised implementation of ESD-intention-to-treat (-ITT).
Methods
ESD Workshops (in-vivo porcine model) lasted 3.3 days including one day theory for 177 participants from 135 Western referral centers. A questionnaire was sent to the senior participant of all 135 centers.
Design
Cross-sectional questionnaire survey.
Main outcome measurements
Performance, organ distribution, severe adverse events of ESD-ITT.
Results
Feedback was received from 113 centers (84%), i.e. 73 (54%) ESD centers and 40 centers (30%) with zero ESD; 10 (7%) had published ESD; no feedback from 12 (9%) centers with unknown status. Altogether, 83 centers (61.5%) perform ESD: 21 (16%) had >150 ESD (professional category), 33 (24%) had 31-150 ESD (competent category), and 29 (21.5%) had ≤Background and aims
Transfer of ESD technique for early gastrointestinal cancer from Japan requires expert-supervised experimental training before unsupervised implementation of clinical ESD.
Aims
To evaluate unsupervised implementation of ESD-intention-to-treat (-ITT).
Methods
ESD Workshops (in-vivo porcine model) lasted 3.3 days including one day theory for 177 participants from 135 Western referral centers. A questionnaire was sent to the senior participant of all 135 centers.
Design
Cross-sectional questionnaire survey.
Main outcome measurements
Performance, organ distribution, severe adverse events of ESD-ITT.
Results
Feedback was received from 113 centers (84%), i.e. 73 (54%) ESD centers and 40 centers (30%) with zero ESD; 10 (7%) had published ESD; no feedback from 12 (9%) centers with unknown status. Altogether, 83 centers (61.5%) perform ESD: 21 (16%) had >150 ESD (professional category), 33 (24%) had 31-150 ESD (competent category), and 29 (21.5%) had ≤ 30 ESD (initial learning category). Most implemented ESD centers (91%, 72 of 79) were analyzed: Centers on initial learning (420 ESD) compared to centers with >30 ESD (5676 ESD) performed en-bloc ESD in 64% vs. 84%, hybrid-ESD in 26% vs.11% and piecemeal-EMR in 10% vs. 5.2%. Majority of ESD (66-68%) were in colorectum, overall with low risk (30-day mortality 0.03%, surgical repair 3.5% vs. 1.7%) and satisfactory outcome (oncosurgery 7.4% vs. 5.2%, local recurrence 1.5% vs. 0.3%).
Conclusions
Beyond guideline recommendations, unsupervised implementation of ESD was successful in colorectum with step-up approach. Now, Western ESD centers have to aim for professional (i.e. >80%) curative ESD.…
