Task Deconstruction of Colonic Endoscopic Submucosal Dissection (cESD): An Expert Consensus

Research output: Contribution to journalArticle

Karen J. Dickinson, Brian J. Dunkin, John J. Nguyen-Lee, Aman B. Ali, Stephanie Zajac

Background: Slow adoption of colonic ESD (cESD) in the US is multifactorial due to: lack of clinical training construct (e.g., gastric ESD in Japan), complication risks, and technical difficulty. More than 28,000 patients/year undergo colonic resection for benign lesions that could be managed effectively with cESD. Selected patients could avoid surgery if procedural adoption of cESD increased due to more accessible training. Current US cESD training is scarce, and existing programs are piecemeal. There is a need to develop an effective national training program for practicing endoscopists. A prerequisite to training development is a comprehensive task list delineating procedural steps. The aim of this work was to describe an evidence-based method of deconstructing cESD into the essential steps to provide a task list to guide teaching and assessment. Methods: Subject-matter experts (SMEs) performed a literature review to create an initial procedural step list. Eleven clinical cESD SMEs and four educational SMEs formed a ‘cESD Working Group’ to develop consensus regarding steps. Through a two-stage modified Delphi process, a consensus on a comprehensive standard cESD deconstructed task list was reached. The aim was to standardize cESD teaching to efficiently bring a novice to safe performance. Results: A literature review identified eight initial cESD steps. First-round Delphi consensus was gained on seven steps. Semi-structured focus group discussions resulted in consensus on a modified version of 7 of the initial steps, with addition of two steps. Consensus on procedural actions needed to perform each step was achieved after the hands-on laboratory. The final result was a ten-step deconstructed task list for standard cESD. Conclusion: The development of a standardized cESD procedural task list provides a foundation to safely and efficiently teach cESD to practicing endoscopists. This list can be used to develop a training pathway to increase procedural adoption. Selected patients currently undergoing colonic resections could benefit from increased adoption of cESD.

Original languageEnglish (US)
Pages (from-to)2401-2408
Number of pages8
JournalWorld Journal of Surgery
Volume44
Issue number7
DOIs
StatePublished - Jul 1 2020

PMID: 32133568

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Task Deconstruction of Colonic Endoscopic Submucosal Dissection (cESD) : An Expert Consensus. / Dickinson, Karen J.; Dunkin, Brian J.; Nguyen-Lee, John J.; Ali, Aman B.; Zajac, Stephanie.

In: World Journal of Surgery, Vol. 44, No. 7, 01.07.2020, p. 2401-2408.

Research output: Contribution to journalArticle

Harvard

Dickinson, KJ, Dunkin, BJ, Nguyen-Lee, JJ, Ali, AB & Zajac, S 2020, 'Task Deconstruction of Colonic Endoscopic Submucosal Dissection (cESD): An Expert Consensus' World Journal of Surgery, vol. 44, no. 7, pp. 2401-2408. https://doi.org/10.1007/s00268-020-05454-w

APA

Dickinson, K. J., Dunkin, B. J., Nguyen-Lee, J. J., Ali, A. B., & Zajac, S. (2020). Task Deconstruction of Colonic Endoscopic Submucosal Dissection (cESD): An Expert Consensus. World Journal of Surgery, 44(7), 2401-2408. https://doi.org/10.1007/s00268-020-05454-w

Vancouver

Dickinson KJ, Dunkin BJ, Nguyen-Lee JJ, Ali AB, Zajac S. Task Deconstruction of Colonic Endoscopic Submucosal Dissection (cESD): An Expert Consensus. World Journal of Surgery. 2020 Jul 1;44(7):2401-2408. https://doi.org/10.1007/s00268-020-05454-w

Author

Dickinson, Karen J. ; Dunkin, Brian J. ; Nguyen-Lee, John J. ; Ali, Aman B. ; Zajac, Stephanie. / Task Deconstruction of Colonic Endoscopic Submucosal Dissection (cESD) : An Expert Consensus. In: World Journal of Surgery. 2020 ; Vol. 44, No. 7. pp. 2401-2408.

BibTeX

@article{6eafae9e4e2941eba36f0b8c6dc6263a,
title = "Task Deconstruction of Colonic Endoscopic Submucosal Dissection (cESD): An Expert Consensus",
abstract = "Background: Slow adoption of colonic ESD (cESD) in the US is multifactorial due to: lack of clinical training construct (e.g., gastric ESD in Japan), complication risks, and technical difficulty. More than 28,000 patients/year undergo colonic resection for benign lesions that could be managed effectively with cESD. Selected patients could avoid surgery if procedural adoption of cESD increased due to more accessible training. Current US cESD training is scarce, and existing programs are piecemeal. There is a need to develop an effective national training program for practicing endoscopists. A prerequisite to training development is a comprehensive task list delineating procedural steps. The aim of this work was to describe an evidence-based method of deconstructing cESD into the essential steps to provide a task list to guide teaching and assessment. Methods: Subject-matter experts (SMEs) performed a literature review to create an initial procedural step list. Eleven clinical cESD SMEs and four educational SMEs formed a ‘cESD Working Group’ to develop consensus regarding steps. Through a two-stage modified Delphi process, a consensus on a comprehensive standard cESD deconstructed task list was reached. The aim was to standardize cESD teaching to efficiently bring a novice to safe performance. Results: A literature review identified eight initial cESD steps. First-round Delphi consensus was gained on seven steps. Semi-structured focus group discussions resulted in consensus on a modified version of 7 of the initial steps, with addition of two steps. Consensus on procedural actions needed to perform each step was achieved after the hands-on laboratory. The final result was a ten-step deconstructed task list for standard cESD. Conclusion: The development of a standardized cESD procedural task list provides a foundation to safely and efficiently teach cESD to practicing endoscopists. This list can be used to develop a training pathway to increase procedural adoption. Selected patients currently undergoing colonic resections could benefit from increased adoption of cESD.",
author = "Dickinson, {Karen J.} and Dunkin, {Brian J.} and Nguyen-Lee, {John J.} and Ali, {Aman B.} and Stephanie Zajac",
year = "2020",
month = "7",
day = "1",
doi = "10.1007/s00268-020-05454-w",
language = "English (US)",
volume = "44",
pages = "2401--2408",
journal = "World Journal of Surgery",
issn = "0364-2313",
publisher = "Springer New York",
number = "7",

}

RIS

TY - JOUR

T1 - Task Deconstruction of Colonic Endoscopic Submucosal Dissection (cESD)

T2 - World Journal of Surgery

AU - Dickinson, Karen J.

AU - Dunkin, Brian J.

AU - Nguyen-Lee, John J.

AU - Ali, Aman B.

AU - Zajac, Stephanie

PY - 2020/7/1

Y1 - 2020/7/1

N2 - Background: Slow adoption of colonic ESD (cESD) in the US is multifactorial due to: lack of clinical training construct (e.g., gastric ESD in Japan), complication risks, and technical difficulty. More than 28,000 patients/year undergo colonic resection for benign lesions that could be managed effectively with cESD. Selected patients could avoid surgery if procedural adoption of cESD increased due to more accessible training. Current US cESD training is scarce, and existing programs are piecemeal. There is a need to develop an effective national training program for practicing endoscopists. A prerequisite to training development is a comprehensive task list delineating procedural steps. The aim of this work was to describe an evidence-based method of deconstructing cESD into the essential steps to provide a task list to guide teaching and assessment. Methods: Subject-matter experts (SMEs) performed a literature review to create an initial procedural step list. Eleven clinical cESD SMEs and four educational SMEs formed a ‘cESD Working Group’ to develop consensus regarding steps. Through a two-stage modified Delphi process, a consensus on a comprehensive standard cESD deconstructed task list was reached. The aim was to standardize cESD teaching to efficiently bring a novice to safe performance. Results: A literature review identified eight initial cESD steps. First-round Delphi consensus was gained on seven steps. Semi-structured focus group discussions resulted in consensus on a modified version of 7 of the initial steps, with addition of two steps. Consensus on procedural actions needed to perform each step was achieved after the hands-on laboratory. The final result was a ten-step deconstructed task list for standard cESD. Conclusion: The development of a standardized cESD procedural task list provides a foundation to safely and efficiently teach cESD to practicing endoscopists. This list can be used to develop a training pathway to increase procedural adoption. Selected patients currently undergoing colonic resections could benefit from increased adoption of cESD.

AB - Background: Slow adoption of colonic ESD (cESD) in the US is multifactorial due to: lack of clinical training construct (e.g., gastric ESD in Japan), complication risks, and technical difficulty. More than 28,000 patients/year undergo colonic resection for benign lesions that could be managed effectively with cESD. Selected patients could avoid surgery if procedural adoption of cESD increased due to more accessible training. Current US cESD training is scarce, and existing programs are piecemeal. There is a need to develop an effective national training program for practicing endoscopists. A prerequisite to training development is a comprehensive task list delineating procedural steps. The aim of this work was to describe an evidence-based method of deconstructing cESD into the essential steps to provide a task list to guide teaching and assessment. Methods: Subject-matter experts (SMEs) performed a literature review to create an initial procedural step list. Eleven clinical cESD SMEs and four educational SMEs formed a ‘cESD Working Group’ to develop consensus regarding steps. Through a two-stage modified Delphi process, a consensus on a comprehensive standard cESD deconstructed task list was reached. The aim was to standardize cESD teaching to efficiently bring a novice to safe performance. Results: A literature review identified eight initial cESD steps. First-round Delphi consensus was gained on seven steps. Semi-structured focus group discussions resulted in consensus on a modified version of 7 of the initial steps, with addition of two steps. Consensus on procedural actions needed to perform each step was achieved after the hands-on laboratory. The final result was a ten-step deconstructed task list for standard cESD. Conclusion: The development of a standardized cESD procedural task list provides a foundation to safely and efficiently teach cESD to practicing endoscopists. This list can be used to develop a training pathway to increase procedural adoption. Selected patients currently undergoing colonic resections could benefit from increased adoption of cESD.

UR - http://www.scopus.com/inward/record.url?scp=85081030883&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85081030883&partnerID=8YFLogxK

U2 - 10.1007/s00268-020-05454-w

DO - 10.1007/s00268-020-05454-w

M3 - Article

VL - 44

SP - 2401

EP - 2408

JO - World Journal of Surgery

JF - World Journal of Surgery

SN - 0364-2313

IS - 7

ER -

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