PTH-017 Registrar-level training in colorectal ESD in western practice: outcomes of independent trainee performed ESD

Introduction There are no published reports on registrar training in colorectal Endoscopic Submucosal Dissection (ESD) in western practice. It is unclear if any such training takes place in western centres where uptake of colorectal ESD has been slow and training, where it exists, is confined to experienced endoscopists who have already completed specialist training. We report our experience of registrar training in ESD and report outcomes from the first 10 cases completed by a trainee unassisted by a trainer. Methods A registrar’s ESD training over a 12 month period was evaluated after sequential training in colonoscopy, magnification endoscopy and endoscopic mucosal resection. The trainee had no prior first-operator experience in ESD. Cases were assigned by the trainer as either ‘trainee to perform part’ or ‘trainee to complete’. Procedures were designated ‘trainee completed, unassisted’ if completed without the trainer handling the endoscope. A standardised ESD technique was employed. Outcomes for trainee completed cases included ESD proficiency (resection speed in cm2/hour), R0 resection and complications. Results The trainee performed part or complete colorectal ESD for 22 cases over the study period of which 10 were completed en bloc unassisted by trainer (mean size 48 mm, range 22 mm-110 mm). 8 of 9 cases assigned ‘trainee to complete’ were successfully completed unassisted, and 2 cases assigned ‘trainee to perform part’ were completed unassisted. Lesions were located in the rectum (n=8) and sigmoid (n=2). 1 case was performed under general anaesthetic due to extreme size (110 mm) and patient tolerance. Mean proficiency for unassisted trainee completed cases was 12.7 cm2/hour. There were no perforations and 1 case of post procedure bleeding managed with observation alone. R0 resection was achieved in 100%, including a case of submucosal invasive cancer. Conclusions Registrar level training in ESD in western centres is feasible and safe. With appropriate prior diagnostic and EMR training, progress in ESD training is rapid and good proficiency (speed of resection) is achieved even for initial unassisted cases whilst clinical and oncological safe outcomes are maintained.