Optimal gastric ESD benchmarks :The learning curve of an untutored Western endoscopist

Abstract

Background & aims Endoscopic submucosal dissection (ESD) is widely used in Asia to resect superficial gastric lesions, but reports on the gastric ESD learning curve of Western endoscopists are scarce. Moreover, it is uncertain whether optimal ESD outcome benchmarks for superficial gastric lesions can be achieved outside Asian countries. We aimed to determine gastric ESD optimal proficiency benchmarks of a Western endoscopist to guide the development of training programs in Western countries. Methods We performed a retrospective analysis of consecutive ESDs performed by a single operator in Bogota, DC, Colombia. ESD was performed in 122 lesions: 104 mucosal (43% low-grade and high-grade dysplasia, 36% well-differentiated adenocarcinoma, 15% moderate and undifferentiated adenocarcinoma, and 6% large hyperplastic lesions) and 18 submucosal. We estimated case volumes required to achieve acceptable and optimal proficiency benchmarks (85-95% and >95% for en bloc resection, 80-90% and >90% for histologic margin-negative (R0) resection, and adverse events 8-16%. and <8%) and determine the number of cases needed to obtain a steady maximal procedural speed.