BACKGROUND & AIMS Endoscopic submucosal dissection (ESD) is widely used in Asia to resect early-stage gastrointestinal neoplasms, but use of ESD in Western countries is limited. We collected data on the learning curve for ESD at a high-volume referral center in the United States to guide development of training programs in the Americas and Europe. METHODS We performed a retrospective analysis of consecutive ESDs performed by a single operator at a high-volume referral center in the United States from 2009 through 2017. ESD was performed in 540 lesions: 449 mucosal (10% esophageal, 13% gastric, 5% duodenal, 62% colonic, and 10% rectal) and 91 submucosal. We estimated case volumes required to achieve accepted proficiency benchmarks (>90% for en bloc resection and >80% for histologic margin-negative (R0) resection) and resection speeds >9cm2/hr. RESULTS Pathology analysis of mucosal lesions identified 95 carcinomas, 346 premalignant lesions, and 8 others; the rate of en bloc resection increased from 76% in block 1 (50 cases) to a plateau of 98% after block 5 (250 cases). The rate of R0 resection improved from 45% in block 1 to >80% after block 5 (250 cases) and ∼95% after block 8 (400 cases). Based on cumulative sum analysis, approximately 170, 150, and 280 ESDs are required to consistently achieve a resection speed >9cm2/hr in esophagus, stomach, and colon, respectively. CONCLUSIONS In an analysis of ESDs performed at a large referral center in the United States, we found that an untutored, prevalence-based approach allowed operators to achieve all proficiency benchmarks after ∼250 cases. Compared with Asia, ESD requires more time to learn in the West, where the untutored, prevalence-based approach requires resection of challenging lesions, such as colon lesions and previously manipulated lesions, in early stages of training.

中文翻译：

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内窥镜黏膜下剥离的学习曲线在美国采用未经指导的、基于患病率的方法。

背景与目的 内窥镜黏膜下剥离术（ESD）在亚洲广泛用于切除早期胃肠道肿瘤，但在西方国家使用 ESD 是有限的。我们在美国的一个大容量转诊中心收集了关于 ESD 学习曲线的数据，以指导美洲和欧洲培训计划的发展。方法 我们对 2009 年至 2017 年在美国一个高容量转诊中心由一名操作员进行的连续 ESD 进行了回顾性分析。 ESD 在 540 个病变中进行：449 个粘膜（10% 食管，13% 胃，5%十二指肠、62% 结肠和 10% 直肠）和 91 黏膜下。我们估计了达到可接受的熟练程度基准所需的病例数（整块切除 >90%，组织学切缘阴性 (R0) 切除 >80%）和切除速度 > 9 平方厘米/小时。结果 粘膜病变的病理学分析确定了 95 例癌、346 例癌前病变和 8 例；整块切除率从块 1（50 例）的 76% 增加到块 5（250 例）后的 98%。R0 切除率从块 1 的 45% 提高到块 5（250 例）后的 >80% 和块 8（400 例）后的约 95%。根据累积总和分析，分别需要大约 170、150 和 280 次 ESD 才能在食道、胃和结肠中始终达到 >9cm2/hr 的切除速度。结论 在对美国一家大型转诊中心进行的 ESD 分析中，我们发现一种未经指导的、基于患病率的方法允许操作员在 250 例左右后达到所有熟练程度基准。与亚洲相比，ESD 需要更多时间在西方学习，