Authors
Jae Hyun Kim
Published in
Clinical endoscopy. Aug 20, 2026. Epub Aug 20, 2026.
Abstract
Colorectal endoscopic submucosal dissection (C-ESD) is a technically demanding procedure with an extended learning curve. We aimed to characterize the learning process after introduction of the pocket-creation method (PCM) and provide practical guidance for endoscopists.
We retrospectively analyzed 147 colorectal lesions treated with PCM-assisted C-ESD. Learning curves for dissection speed and procedure time were evaluated using locally weighted regression. Cumulative sum (CUSUM) analysis was used to identify the point of technical stabilization, with a predefined acceptable failure rate of 10%. Outcomes were compared between the pre- and post-stabilization phases, and multivariate logistic regression was used to identify the predictors of technical failure.
Dissection speed increased and procedure time decreased with experience. CUSUM analysis identified stabilization at 60 cases. Compared with the post-stabilization phase, the pre-stabilization phase showed higher technical failure rates and lower en bloc and R0 resection rates. The learning phase was the only independent predictor of technical failure. Perforation occurred in 5.4% of cases and was managed predominantly endoscopically.
PCM-assisted C-ESD showed a distinct learning curve, with stabilization achieved after 60 cases. Technical failure is primarily driven by operator experience rather than by lesion complexity.
PMID:
42681911
Bibliographic data and abstract were imported from PubMed on 02 Sep 2026.
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