Year 2023 / Volume 115 / Number 11
Original
Learning curve for endoscopic resection of gastric gastrointestinal stromal tumors: a single-center experience

601-607

DOI: 10.17235/reed.2023.9441/2022

Luojie Liu, Xiaodan Xu, Wendao You, Dongtao Shi, Rui Li, Chao Ma,

Abstract
Background: endoscopic resection (ER) is widely used in the treatment of gastric gastrointestinal stromal tumors (gGISTs). However, no studies have previously described the learning curve (LC) for ER of gGISTs. This study aimed to evaluate the LC based on multifarious operative outcomes. Methods: one hundred consecutive patients who underwent ER of gGISTs by a single endoscopist from January 2017 to December 2022 were included. Patients were analyzed in groups of ten to minimize demographic differences, and operative time (OT), conversion rate, intraoperative and postoperative complication were assessed to evaluate the LC. Meanwhile, for the OT, the LC was further analyzed using the cumulative sum (CUSUM) method and patients were organized chronologically in three phases. Result: there was a statistically significant decrease in OT, conversion to laparoscopic surgery, and postoperative complication after 30 cases (median 80.0 min vs 56.0 min, p < 0.001; 10.0 % vs 0 %, p = 0.025; 33.3 % vs 10.0 %, p = 0.004), rate of intraoperative complications after 20 cases (15.0 % vs 1.3 %, p = 0.025). CUSUM chart demonstrated that OT increased dramatically before around 30 cases (phase 1) and decreased after 60 cases (phase 3), with a plateau phase in the middle 30 cases (phase 2). Among the three phases, the R0 resection and conversion rate were not significantly different. However, OT, intraoperative and postoperative complications were gradually decreased (p < 0.05). Conclusions: the LC of ER of gGISTs is approximately 60 cases. However, about 30 cases were sufficient to acquire skills to reduce complications and conversion rate during the ER procedure.
Lay Summary
This study analyzed the learning curve (LC) for endoscopic resection (ER) of gastric gastrointestinal stromal tumors (gGISTs) based on operative outcomes, including operative time, conversion rate, and intra- and postoperative complications. The study included 100 consecutive patients who underwent ER of gGISTs by a single endoscopist, analyzed in groups of 10 to minimize demographic differences and operative time. The results showed a significant decrease in operative time, conversion to laparoscopic operation, and postoperative complication after 30 cases, and in intraoperative complication after 20 cases. The cumulative sum chart demonstrated a rise in operative time before about 30 cases, followed by a decrease after 60 cases, with a plateau in the middle 30 cases. The study concluded that the LC of ER of gGISTs is about 60 cases, with around 30 cases being sufficient to develop skills in reducing complications and conversion rate during ER procedure.
Share Button
New comment
Comments
No comments for this article
References
1.Nishida T, Kawai N, Yamaguchi S, et al. Submucosal tumors: comprehensive guide for the diagnosis and therapy of gastrointestinal submucosal tumors. Dig Endosc. 2013 Sep;25(5):479-89. doi: 10.1111/den.12149.
2. MacArthur KM, Baumann BC, Nicholl MB. Laparoscopic Versus Open Resection for Gastrointestinal Stromal Tumors (GISTs). J Gastrointest Cancer. 2017 Mar;48(1):20-24. doi: 10.1007/s12029-016-9861-1.
3. Andalib I, Yeoun D, Reddy R, et al. Endoscopic resection of gastric gastrointestinal stromal tumors originating from the muscularis propria layer in North America: methods and feasibility data. Surg Endosc. 2018 Apr;32(4):1787-1792. doi: 10.1007/s00464-017-5862-9. Epub 2017 Sep 15.
4. Locatelli A, Carzaniga D, Carzaniga P, et al. Laparoscopic versus open resection for the treatment of gastric GIST: a retrospective 10-year single-center experience. Minerva Surg. 2022 Oct;77(5):468-472. doi: 10.23736/S2724-5691.21.09119-X.
5. Wang C, Gao Z, Shen K, et al. Safety and efficiency of endoscopic resection versus laparoscopic resection in gastric gastrointestinal stromal tumours: A systematic review and meta-analysis. Eur J Surg Oncol 2020; 46(4 Pt A):667-74. DOI: 10.1016/j.ejso.2019.10.030
6. Chen L, Zhang Q, Li FY, et al. Comparison of treatment outcomes between laparoscopic and endoscopic surgeries for relatively small gastric gastrointestinal stromal tumors. Surg Oncol 2018; 27(4):737-42. DOI: 10.1016/j.suronc.2018.10.002
7. Su W, Wang M, Zhang D, et al. Predictors of the difficulty for endoscopic resection of gastric gastrointestinal stromal tumor and follow-up data. J Gastroenterol Hepatol. 2022 Jan;37(1):48-55. doi: 10.1111/jgh.15650.
8. Muro T, Higuchi N, Imamura M, et al.Post-operative infection of endoscopic submucosal dissection of early colorectal neoplasms: a case-controlled study using a Japanese database. J Clin Pharm Ther. 2015 Oct;40(5):573-577. doi: 10.1111/jcpt.12313.
9. Draganov PV, Aihara H, Karasik MS, et al. Endoscopic Submucosal Dissection in North America: A Large Prospective Multicenter Study. Gastroenterology. 2021 Jun;160(7):2317-2327.e2. doi: 10.1053/j.gastro.2021.02.036.
10. Song X, Wang D, Sun X, et al. Cumulative sum analysis of the learning curve for endoscopic resection of juvenile nasopharyngeal angiofibroma. Surg Endosc. 2018 Jul;32(7):3181-3191. doi: 10.1007/s00464-018-6035-1.
11. Ozeki Y, Hirasawa K, Sawada A, et al. Learning curve analysis for duodenal endoscopic submucosal dissection: A single-operator experience. J Gastroenterol Hepatol. 2022 Nov;37(11):2131-2137. doi: 10.1111/jgh.15995.
12. Huberty V, Verset L, Deviere J. Endoscopic full-thickness resection of a gastric GI stromal tumor. VideoGIE. 2019 Jan 17;4(3):120-122. doi: 10.1016/j.vgie.
13. Pimentel-Nunes P, Dinis-Ribeiro M, Ponchon T, et al. Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2015; 47(9):829-54. DOI: 10.1055/s-0034-1392882
14. Casali PG, Abecassis N, Aro HT, et al. Gastrointestinal stromal tumours: ESMO-EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2018 Oct 1;29(Suppl 4):iv68-iv78. doi: 10.1093/annonc/mdy095. Erratum in: Ann Oncol. 2018 Oct 1;29(Suppl 4):iv267.
15. Akahoshi K, Oya M, Koga T, et al. Current clinical management of gastrointestinal stromal tumor. World J Gastroenterol. 2018 Jul 14;24(26):2806-2817. doi: 10.3748/wjg.v24.i26.2806.
16. Sun C, Zheng Z, Wang B. Learning curve for endoscopic submucosal dissection of gastric submucosal tumors: is it more difficult than it may seem? J Laparoendosc Adv Surg Tech A. 2014 Sep;24(9):623-7. doi: 10.1089/lap.2014.0122.
17. Yoshida M, Kakushima N, Mori K, et al. Learning curve and clinical outcome of gastric endoscopic submucosal dissection performed by trainee operators. Surg Endosc. 2017 Sep;31(9):3614-3622. doi: 10.1007/s00464-016-5393-9.
18. Hatta W, Koike T, Abe H, et al. Recent approach for preventing complications in upper gastrointestinal endoscopic submucosal dissection. DEN Open. 2021 Oct 31;2(1):e60. doi: 10.1002/deo2.60.
19. Meng Y, Li W, Han L, et al. Long-term outcomes of endoscopic submucosal dissection versus laparoscopic resection for gastric stromal tumors less than 2 cm. J Gastroenterol Hepatol. 2017 Oct;32(10):1693-1697. doi: 10.1111/jgh.13768.
20. Yin X, Yin Y, Chen H, et al. Comparison Analysis of Three Different Types of Minimally Invasive Procedures for Gastrointestinal Stromal Tumors ≤5 cm. J Laparoendosc Adv Surg Tech A. 2018 Jan;28(1):58-64. doi: 10.1089/lap.2017.0305.
Related articles

Digestive Diseases Image

Endoscopic resection of a descending duodenal polyp with the string-clip traction

DOI: 10.17235/reed.2022.8915/2022

Original

Implementation of a peroral endoscopic myotomy program

DOI: 10.17235/reed.2020.7116/2020

Review

Device-assisted enteroscopy training. A rapid review

DOI: 10.17235/reed.2020.6923/2020

Letter to the Editor

Leiomyosarcoma of the ascending colon: a rare tumor with poor prognosis

DOI: 10.17235/reed.2015.3606/2014

Citation tools
Liu L, Xu X, You W, Shi D, Li R, Ma C, et all. Learning curve for endoscopic resection of gastric gastrointestinal stromal tumors: a single-center experience. 9441/2022


Download to a citation manager

Download the citation for this article by clicking on one of the following citation managers:

Metrics
This article has received 430 visits.
This article has been downloaded 51 times.

Statistics from Dimensions


Statistics from Plum Analytics

Publication history

Received: 23/12/2022

Accepted: 25/04/2023

Online First: 12/05/2023

Published: 13/11/2023

Article revision time: 104 days

Article Online First time: 140 days

Article editing time: 325 days


Share
This article hasn't been rated yet.
Reader rating:
Valora este artículo:




Asociación Española de Ecografía Digestiva Sociedad Española de Endoscopia Digestiva Sociedad Española de Patología Digestiva
The Spanish Journal of Gastroenterology is the official organ of the Sociedad Española de Patología Digestiva, the Sociedad Española de Endoscopia Digestiva and the Asociación Española de Ecografía Digestiva
Cookie policy Privacy Policy Legal Notice © Copyright 2023 y Creative Commons. The Spanish Journal of Gastroenterology