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Predictors of technical difficulty for trainees in esophageal endoscopic submucosal dissection

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Abstract

Background

Esophageal endoscopic submucosal dissection (ESD) is technically challenging, especially for trainees, and requires a safe training system. This study aimed to identify predictors of technical difficulty facing trainees performing esophageal ESD to establish such system.

Methods

This was a single-center retrospective study of patients with esophageal cancer who underwent ESD performed by trainees between January 2010 and August 2022. Technical difficulties were defined as muscularis propria exposure and long procedure time (≥ 90 min). Factors associated with these technical difficulties were investigated.

Results

A total of 798 lesions in 721 patients were evaluated. Muscularis propria exposure occurred in 298 lesions (37.3%), including 10 perforations (1.3%). The procedure time was ≥ 90 min in 134 lesions (16.8%). In the multivariate analysis, tumor size ≥ 20 mm, tumors ≥ 1/2 of the circumference, and those close to previous treatment scars significantly increased the incidence of both difficulties, whereas tumors in the upper esophagus significantly decreased this incidence. Furthermore, female sex and tumors in the left wall were independent predictors of muscularis propria exposure, and elevated morphology was an independent predictor of long procedure time. Muscularis propria exposure and long procedure time occurred in more than half of the cases with three or more predictors of each difficulty.

Conclusions

Large tumors and tumors close to previous treatment scars increase technical difficulties for trainees in esophageal ESD. Conversely, tumors in the upper esophagus reduce these difficulties. These results enable us to predict the difficulty level preoperatively and select appropriate cases in stepwise training.

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Data availability

The datasets generated and analyzed in this study are available from the corresponding author upon reasonable request.

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Acknowledgements

We gratefully acknowledge the work of past and present members of our institution. Moreover, we would like to thank Editage (www.editage.com) for the English language editing.

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Authors and Affiliations

  1. Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-Ku, Osaka, 541-8567, Japan

    Tomoya Ueda, Ryu Ishihara, Shunsuke Yoshii, James Weiquan Li, Yuya Asada, Daiki Kitagawa, Atsuko Kizawa, Takehiro Ninomiya, Yuki Okubo, Yushi Kawakami, Yasuhiro Tani, Satoki Shichijo, Takashi Kanesaka, Sachiko Yamamoto, Yoji Takeuchi, Koji Higashino, Noriya Uedo & Tomoki Michida

  2. Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore, Singapore

    James Weiquan Li

  3. Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Maebashi, Japan

    Yoji Takeuchi

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  1. Tomoya Ueda
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  2. Ryu Ishihara
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  14. Sachiko Yamamoto
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  15. Yoji Takeuchi
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  16. Koji Higashino
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Corresponding author

Correspondence to Ryu Ishihara.

Ethics declarations

Ethics approval

This study was approved by the Institutional Review Board of the Osaka International Cancer Institute and performed in accordance with the 2013 revision of the Declaration of Helsinki.

Patient consent

We used the opt-out method to obtain informed consent for this study.

Conflict of interests

Ryu Ishihara has received honoraria from Olympus, FUJIFILM medical, Daiichi-Sankyo, Miyarisan Pharmaceutical, AI Medical Service, Astra Zeneca, MSD, and Ono Pharmaceutical. James Weiquan Li has received honoraria from Boston Scientific and FUJIFILM medical. Satoki Shichijo has received honoraria from Olympus, EA Pharma, AstraZeneca, AI Medical Service, and Janssen Pharmaceutical. Takashi Kanesaka has received honoraria from Olympus, AstraZeneca, and AI Medical Service. Yoji Takeuchi has received honoraria from Olympus, Boston Scientific, Takeda Pharmaceutical Company, EA Pharma, Zeria Pharmaceutical, and Viatris. Noriya Uedo has received honoraria from Olympus, FUJIFILM medical, Boston Scientific, Daiichi-Sankyo, Takeda Pharmaceutical, EA Pharma, Otsuka Pharmaceutical, AstraZeneca, Miyarisan Pharmaceutical, and AI Medical Service. Tomoya Ueda, Shunsuke Yoshii, Yuya Asada, Daiki Kitagawa, Atsuko Kizawa, Takehiro Ninomiya, Yuki Okubo, Yushi Kawakami, Yasuhiro Tani, Sachiko Yamamoto, Koji Higashino, and Tomoki Michida declare that they have no conflict of interest.

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Ueda, T., Ishihara, R., Yoshii, S. et al. Predictors of technical difficulty for trainees in esophageal endoscopic submucosal dissection. Esophagus 21, 58–66 (2024). https://doi.org/10.1007/s10388-023-01028-6

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  • DOI: https://doi.org/10.1007/s10388-023-01028-6

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