Double channel endoscopic mucosal resection for advanced polyps: teaching “young dogs” new tricks

Introduction Endoscopic mucosal resection (EMR) is a treatment for advanced colorectal polyps but can be challenging to adopt without advanced training or substantial experience. It is unclear if double channel endoscopy (DC) can facilitate learning. Methods: Patients who underwent DC-EMR were identified. Patient data was stratified by experience level: novice or expert. Expert endoscopists being those who have performed at least 30 DC-EMRs. Primary outcomes were differences in gross complete resection, procedure time, complications and interval polyp recurrence. Results: There were141 patients who underwent an attempt at DC-EMR. Of those,135 (96%) underwent complete endoscopic resection and 6 had an incomplete resection. Recurrent polyp was noted in 6 patients (6.8%) at 12-month follow-up, and in 8 additional patients (9.1%) who had longer follow-up. The overall incidence of recurrence was 15.9% (CI=9.6-25.1%). Sixty-five procedures were performed by 4 novice endoscopists (26, 19, 12, and 8 cases). One expert endoscopist performed the remaining 76 (55%) procedures. There was no difference between the groups in operative time (123 vs 113 vs min, p=0.39) or gross complete endoscopic resection (95% vs 100%, p= 0.10). There were fewer complications for the novice endoscopists (0 vs 6, p=0.03) and a trend toward a higher incidence of recurrence for the novice endoscopists (25% vs 9.6%, p=0.08). Conclusions: Novice endoscopists can successfully perform DC-EMR with similar operative time and successful resection compared to expert endoscopists, though with a trend toward higher recurrence. DC-EMR can be safely adopted by early practicing endoscopists with appropriate mentorship and institutional support.