Orthodontic rubber band traction improves trainees' learning curve of colorectal endoscopic submucosal dissection: a prospective randomized study.

Backgroud And Study Aims: Colorectal endoscopic submucosal dissection (ESD) is a technically demanding operation with a long learning curve. This study aimed 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.

Patients And 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 mm2/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 three 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.

Conclusion: 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.