Meta-Analysis
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Apr 16, 2015; 7(4): 417-428
Published online Apr 16, 2015. doi: 10.4253/wjge.v7.i4.417
Impact of formal training in endoscopic submucosal dissection for early gastrointestinal cancer: A systematic review and a meta-analysis
Miguel A Tanimoto, M Lourdes Guerrero, Yoshinori Morita, Jonathan Aguirre-Valadez, Elisa Gomez, Carlos Moctezuma-Velazquez, Jose A Estradas-Trujillo, Miguel A Valdovinos, Luis F Uscanga, Rikiya Fujita
Miguel A Tanimoto, M Lourdes Guerrero, Jonathan Aguirre-Valadez, Elisa Gomez, Carlos Moctezuma-Velazquez, Jose A Estradas-Trujillo, Miguel A Valdovinos, Luis F Uscanga, National Institute of Medical Sciences and Nutrition Salvador Zubiran, 14000 Mexico City, Mexico
Yoshinori Morita, Kobe University School of Medicine, Department of Gastroenterology, Chuo-ku, Kobe 650-0017, Japan
Rikiya Fujita, Yokohama Shin-midori General Hospital, Midori-ku, Yokohama, Kanagawa 226-0025, Japan
Author contributions: All authors contributed to this work.
Conflict-of-interest: All authors declare non conflict-of-interest.
Data sharing: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Miguel A Tanimoto, MD, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Vasco de Quiroga # 15, Del. Tlalpan, 14000 Mexico City, Mexico. matanimoto@prodigy.net.mx
Telephone: +52-55-55733418 Fax: +52-55-56665982
Received: September 7, 2014
Peer-review started: September 9, 2014
First decision: October 28, 2014
Revised: January 22, 2015
Accepted: February 4, 2015
Article in press: February 9, 2015
Published online: April 16, 2015
Abstract

AIM: To summarize the clinical impact of a formal training for the effectiveness and safety of endoscopic submucosal dissection for gastrointestinal cancer.

METHODS: We searched databases including PubMed, EMBASE and the Cochrane Library and Science citation Index updated to August 2014 to include eligible articles. In the Meta-analysis, the main outcome measurements were en bloc resection rate, local recurrence rate (R0) and the incidence of procedure-related complications (perforation, bleeding).

RESULTS: En bloc resection was high for both, dissecting stomach tumors with an overall percentage of 93.2% (95%CI: 90.5-95.8) and dissecting colorectal tumors with an overall percentage of 89.4% (95%CI: 85.1-93.7). Although the number of studies reporting R0 resection (the dissected specimen was revealed free of tumor in both vertical and lateral margins) was small, the overall estimates for R0 resection were 81.4% (95%CI: 72-90.8) for stomach and 85.9% (95%CI: 77.5-95.5) for colorectal tumors, respectively. The analysis showed that the percentage of immediate perforation and bleeding were very low; 4.96 (95%CI: 3.6-6.3) and 1.4% (95%CI: 0.8-1.9) for colorectal tumors and 3.1% (95%CI: 2.0-4.1) and 4.8% (95%CI: 2.8-6.7) for stomach tumors, respectively.

CONCLUSION: In order to obtain the same rate of success of the analyzed studies it is a necessity to create training centers in the western countries during the “several years” of gastroenterology residence first only to teach EGC diagnose and second only to train endoscopic submucosal dissection.

Keywords: Endoscopic submucosal dissection, Training

Core tip: Endoscopic submucosal dissection (ESD) has gained widespread use in Asia because of a well-documented higher en bloc and curative resection rates for early neoplastic gastrointestinal lesions. Unfortunately, ESD has not been yet widespread in the West due to remain the very flat learning curve and lack of training resources. In Asia, ESD skills are acquired in the time-honored mentor/apprentice model over a period of few years. Although, there is a great heterogeneity in the medical literature reports about training and learning curve of ESD. In this meta analysis we had analyzed the results from these training centers reports. Because technical maturation often requires measurable standard to achieve.