Endoscopic submucosal dissection: Italian national survey on current practices, training and outcomes.

Roberta Maselli, Federico Iacopini, Francesco Azzolini, Lucio Petruzziello, Mauro Manno, Luca De Luca, Paolo Cecinato, Giancarla Fiori, Teresa Staiano, Erik Rosa Rizzotto, Stefano Angeletti, Angelo Caruso, Franco Coppola, Gianluca Andrisani, Edi Viale, Guido Missale, Alba Panarese, Alessandro Mazzocchi, Paola Cesaro, Mariachiara CampanalePietro Occhipinti, Ottaviano Tarantino, Cristiano Crosta, Piero Brosolo, Sandro Sferrazza, Emanuele Rondonotti, Arnaldo Amato, Lorenzo Fuccio, Guido Costamagna, Alessandro Repici

Research output: Contribution to journalArticle

Abstract

Background and Aims: Most of the evidence supporting endoscopic submucosal dissection (ESD) comes from Asia. European data are primarily reported by specialized referral centers and thus may not be representative of common European ESD practice. The aim of this study is to understand the current state of ESD practice across Italian endoscopy centers. Methods: All Italian endoscopists who were known to perform ESD were invited to complete a structured questionnaire including: operator features and competencies, ESD training details and clinical outcomes over a 2-year period. Results: Twenty-nine operators from 23 centers (69% response rate) completed the questionnaire: 18 (62%) were <50 years old; 7 (24%) were female; 16 (70%) were located in Northern Italy. Overall ESD volume was <40 cases in 9 (31%) operators, 40–80 in 8 (27.5%), 80–150 in 4 (13.8%) and >150 in 8 (27.5%). Colorectal ESD was predominant for operators with an experience >80 cases. En-bloc resection rates ranged from 77.2 to 97.2% depending on the anatomic location with an R0 resection rate range of 75.3–93.6%. ESD perforation rates in the colon and rectum were significantly lower when experience was >150 compared to 80–150 cases (p < 0.0001 and p = 0.006 for colon and rectum, respectively). Conclusion: ESD in Italy is performed by a significant number of operators. Overall, Italian endoscopists performing ESD have achieved a good competence level. However, there is much variability in training protocols, initial supervision of procedures, practice settings, case mix and procedural volume/year that are likely responsible for some of the suboptimal resectional outcomes and increased perforation risk, mainly in the colon. Standardized training programs, practice parameters and auditing of outcomes are required.

Original languageEnglish
JournalDigestive and Liver Disease
DOIs
Publication statusE-pub ahead of print - Oct 17 2019

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Keywords

  • Early GI tumor
  • Endoscopy
  • ESD
  • Survey

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Maselli, R., Iacopini, F., Azzolini, F., Petruzziello, L., Manno, M., De Luca, L., Cecinato, P., Fiori, G., Staiano, T., Rosa Rizzotto, E., Angeletti, S., Caruso, A., Coppola, F., Andrisani, G., Viale, E., Missale, G., Panarese, A., Mazzocchi, A., Cesaro, P., ... Repici, A. (2019). Endoscopic submucosal dissection: Italian national survey on current practices, training and outcomes. Digestive and Liver Disease. https://doi.org/10.1016/j.dld.2019.09.009