Abstract
INTRODUCTION: Colorectal endoscopic submucosal dissection (ESD) is a technically demanding operation with a long learning curve. The aim of this study was to determine whether orthodontic rubber band (ORB)-assisted colorectal ESD could improve the trainees' learning curve as it was shown to shorten colorectal ESD procedure time in trainees and experts. METHODS: This prospective, randomized, controlled clinical study involved 178 patients who underwent colorectal ESD, randomly divided into trainee ORB-assisted ESD (Trainee ORB-ESD; n = 60), trainee conventional ESD (Trainee C-ESD; n = 57), and expert conventional ESD (Expert C-ESD; n = 61) groups. The main outcome was procedure time. RESULTS: Per Protocol analysis showed a similar operative time in the trainee ORB-ESD and expert C-ESD groups, which was shorter than in the trainee C-ESD group [28.0 (21.0-35.0) and 25.0 (15.0-35.0) vs 41.0 (31.0-52.5) min; ( P < 0.001)]. The trainee ORB-ESD, trainee C-ESD, and expert C-ESD groups differed significantly in resection speed (11.35, 9.07, and 12.56 mm 2 /min, respectively), good visual field exposure rate (96.7%, 80.7%, and 93.4%), and muscle injury rate (5.0%, 17.5%, and 6.6%). However, the trainee ORB-ESD and expert C-ESD groups were similar in these measures, and all 3 groups were similar in adverse events, en bloc resection, R0 resection, and pathology rates. The cumulative sum suggested that the learning inflection point of the trainee ORB-ESD group was earlier than that of the trainee C-ESD group. DISCUSSION: ORB-ESD shortened colorectal ESD procedure time and improved efficiency in trainees to an expert level. ORB-ESD could shorten the learning curve, justifying its widespread application.