Endoscopic resection of superficial bowel neoplasia: The unmet needs in the Egyptian practice

Table 1 Demographic characteristics of the surveyed physicians

Variable	Frequency (n = 833)	Percent (%)
Gender
Male	560	67.2
Female	273	32.8
Age (yr)
≤ 35	276	33.1
36-45	366	43.9
> 45	191	22.9
Academic categories
Consultants	464	55.7
Residents	36	4.3
Specialist	333	40.0
Career specialty
Gastroenterologist	678	81.4
General medicine	121	14.5
Surgery	34	4.1
Years of practice (yr)
< 5	145	17.4
5-10	120	14.4
10-15	200	24.0
> 15	368	44.2
Main hospital of practice
Central	80	9.6
General	111	13.3
Teaching institution	73	8.8
University	569	68.3

Table 2 Assessment of knowledge among the surveyed physicians

Variable	Number	Percent
What is superficial bowel neoplasia?
True	736	88.4
False	97	11.6
Superficial bowel neoplasia can be diagnosed with?
True	547	65.7
False	286	34.3
What is the best option for the treatment of bowel cancer in general?
True	473	56.8
False	360	43.2
What is the best treatment for superficial bowel neoplasia?
True	526	63.1
False	307	36.9
What does polypectomy mean?
True	767	92.1
False	66	7.9
What does EMR stand for?
True	751	90.2
False	82	9.8
What does ESD stand for?
True	742	89.1
FalseE	91	10.9
The best endoscopic treatment option for pedunculated polyps
True	609	73.1
False	224	26.9
The best endoscopic treatment option for non-pedunculated lesions ≤ 15 mm in diameter
True	473	56.8
False	360	43.2
The best endoscopic treatment option for non-pedunculated lesions ≥ 20 mm
True	421	50.5
False	412	49.5
Endoscopic resection is a suitable treatment?
True	596	71.5
False	237	28.5

Table 3 Attitude of the surveyed physicians towards superficial bowel neoplasia

Question (%)	Frequency	Percent
How frequently do you refer your patients for endoscopic screening of superficial bowel cancer in high-risk groups? (% of the high-risk patients you see)
0	102	12.2
25	386	46.3
50	116	13.9
75	103	12.4
100	126	15.1
How convinced you are with endoscopic treatment of superficial bowel cancer?
Convinced	567	68.1
I don't Know	175	21
Not convinced at all	91	10.9
How frequently do you refer a patient with endoscopic features of superficial bowel cancer for endoscopic resection? (% of the patients you see)
0	235	28.2
25	301	36.1
50	115	13.8
75	108	13
100	74	8.9
How frequently do you refer a patient with endoscopic features of superficial bowel cancer for surgical management? (% of the patients you see)
0	147	17.6
25	290	34.8
50	212	25.5
75	64	7.7
100	120	14.4
In your institution do you have a panel to discuss the treatment options for superficial bowel neoplasia?
No	518	62.2
Yes	315	37.8

Table 4 Basic endoscopic practice knowledge for endoscopic resection techniques among the surveyed endoscopists

Question	Number (N = 570)	Percentage (%)
Are you trained formally on endoscopic polypectomy?
No	134	23.5
Yes	436	76.5
Are you trained formally on EMR?
No	388	68.1
Yes	182	31.9
Are you trained formally on ESD?
No	528	92.6
Yes	42	7.4
Do you use Paris classification in reporting the lesions?
No	239	41.9
Yes	331	58.1
Do you use Kudo classification in reporting the lesions?
No	371	65.1
Yes	199	34.9
Do you use classifications other than Paris and Kudo in reporting the lesions?
No	510	89.5
Yes	60	10.5
Which of the following practices increase sub-mucosal fibrosis and hence affect the success of advanced endoscopic resection techniques
All apply	363	63.7
Extensive biopsies	117	20.5
Partial snare polypectomy	24	4.2
Tattoo injection for marking immediately under or close by a lesion	66	11.6

EMR: Endoscopic mucosal resection; ESD: Endoscopic submucosal dissection.

Table 5 Individual competency in endoscopic resection techniques among the surveyed endoscopists

Question	Number (N = 570)	Percentage (%)
How many polyps did you excised in the last year?
0	384	67.4
11-20	96	16.8
21-30	30	5.3
41-50	36	6.3
Less than 10	12	2.1
More than 50	12	2.1
How many EMRs did you perform in the last year?
0	408	71.6
10-20	48	8.4
20-30	12	2.1
Less than 10	102	17.9
How many ESDs did you perform in the last year?
0	504	88.4
10-20	12	2.1
Less than 10	54	9.5
How many complications from endoscopic resection techniques have you had in the last year (% of your total cases)?
0	329	57.7
0.25	91	16.0
0.5	12	2.1
I don't practice advanced endoscopic techniques	138	24.2
How competent are you in managing the complications of endoscopic resection techniques?
Competent	147	25.8
I am not sure	284	49.8
Non-competent	139	24.4

EMR: Endoscopic mucosal resection; ESD: Endoscopic submucosal dissection.

Table 6 Parameters of the endoscopy units’ infrastructures among the surveyed endoscopists

%	Number (n = 570)	Percent
How many independent endoscopists are in your unit?
Less than 5	170	29.8
5-10	164	28.8
More than 10	236	41.4
The nursing staff in your endoscopy unit are knowledgeable and trained on endoscopic resection techniques
No	297	52.1
Yes	273	47.9
How sufficient is the number of endoscopes in your unit to perform all endoscopy duties?
I am not sure	36	6.3
Not- Sufficient	310	54.4
Sufficient	224	39.3
How many endoscopes with optical enhancement (NBI- i-SCAN- FICE) are available in your unit (% of the total scopes in your unit)
0.00	135	23.7
25.00	242	42.5
50.00	126	22.1
75.00	43	7.5
100.00	24	4.2
Dyes for chromoendoscopy are available in your unit
No	455	79.8
Yes	115	20.2
Advanced Diathermy unit with different endoscopy modes is available in your unit
No	181	31.8
Yes	389	68.2
APC is available in your unit
No	61	10.7
Yes	509	89.3
Haemoclips are available in your unit
No	79	13.9
Yes	491	86.1
In your endoscopy unit, the endoscopic resection techniques are operated under anesthesiologist’s observation
No	110	19.3
Yes	460	80.7
The most commonly reported complications from endoscopic resection techniques in your unit
Delayed bleeding	24	4.2
Perforations,	97	17.0
Procedural bleeding	152	26.7
Sedation or anesthesia-related	12	2.1
We do not perform advanced endoscopic resection	285	50.0
Your institution is ready for managing the complications of endoscopic resection techniques?
I am not sure	218	38.2
No	42	7.4
Yes	310	54.4
The surgical backup team is usually ready to manage complications of your cases
No	157	27.5
Yes	413	72.5
How many complicated cases following endoscopic resection treated under surgical repair in the last one year within your institution (% from complicated cases)
0.00	430	75.4
25.00	74	13.0
50.00	30	5.3