An effective training system for endoscopic submucosal dissection of gastric neoplasm
An effective training system for endoscopic submucosal dissection of gastric neoplasm
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DOI：
10.1055/s-0031-1291383
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发表时间：
2011-12-01
期刊：
影响因子：
9.3
通讯作者：
Koike, K.
中科院分区：
文献类型：
--
作者：
Tsuji, Y.;Ohata, K.;Koike, K.
背景和研究目的：内镜黏膜下剥离术（ESD）的标准培训系统仍有待建立。在这项研究中，我们评估了我们的培训计划的有效性为gastric ESD.Patients和方法：四名学员进行了胃ESD的107例患者（27至30个连续病变每名学员），共117病变在三级转诊中心在2年的培训计划。已经掌握ESD所需的基本技能和知识的受训者每人协助进行40次胃ESD手术，然后在20例病例中对胃粘膜缺损进行ESD后凝固（PEC）;然后他们开始进行ESD，从胃窦病变开始。治疗结果，包括平均手术时间，整块切除率，整块加R 0切除，并发症和自我完成，进行了评价，为最初的15和随后的12至15 cases.Results：整块切除和整块加R 0切除的总体率分别高达100%和96.6%，分别。关于并发症，发生了7例迟发性出血（6.0%）和3例穿孔（2.6%）;所有并发症均在内镜下解决。更换术者最常见的原因是缺乏粘膜下剥离技术。自我完成率超过80%，即使在早期，并没有增加，为后来的cases.Conclusions：我们的培训系统，使新手操作者进行胃ESD的临床结果没有下降。该培训的主要特点是事先强化学习和在专家监督下学习期间的实际ESD。
Background and study aims: A standard training system for endoscopic submucosal dissection (ESD) remains to be established. In this study, we evaluated the validity of our training program for gastric ESD.Patients and methods: Four trainees performed gastric ESD for a total of 117 lesions in 107 patients (27 to 30 consecutive lesions per trainee) at a tertiary referral center during 2 years in the training program. Trainees, who already had the fundamental skills and knowledge needed for ESD, each assisted at 40 gastric ESD procedures, then in 20 cases applied post-ESD coagulation (PEC) to gastric mucosal defects; they then began to perform ESD, starting with gastric antral lesions. Treatment outcomes, including mean procedure time, and rates of en bloc resection, en bloc plus R0 resections, complications, and self-completion, were evaluated, for the initial 15 and subsequent 12 to 15 cases.Results: Overall rates of en bloc resection and en bloc plus R0 resection were as high as 100% and 96.6 %, respectively. Regarding complications, seven cases of delayed hemorrhage (6.0 %) and three cases of perforation (2.6 %) occurred; all complications were solved endoscopically. The most frequent reason for operator change was lack of submucosal dissection skill. The self-completion rate was more than 80% even in the early period, and did not increase for later cases.Conclusions: Our training system enabled novice operators to perform gastric ESD without a decline in clinical outcomes. Key features of this training are prior intensive learning and actual ESD during the learning period under expert supervision.