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.

中文翻译：

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正畸橡皮筋牵引改善受训者结直肠内窥镜粘膜下剥离术的学习曲线：一项前瞻性随机研究。


背景和研究目标 结直肠内窥镜粘膜下剥离术 （ESD） 是一项技术要求高且学习曲线长的操作。本研究旨在确定正畸橡皮筋 （ORB） 辅助的结直肠 ESD 是否可以改善受训者的学习曲线，因为它被证明可以缩短受训者和专家的结直肠 ESD 手术时间。患者和方法 这项前瞻性、随机、对照临床研究涉及 178 名接受结直肠 ESD 的患者，随机分为实习生 ORB 辅助 ESD （实习生 ORB-ESD;n=60）、实习生常规 ESD （实习生 C-ESD;n=57）和专家常规 ESD （专家 C-ESD;n=61） 组。主要结局是手术时间。结果：根据方案分析显示，实习生 ORB-ESD 组和专家 C-ESD 组的手术时间相似，短于实习生 C-ESD 组 [28.0 （21.0-35.0） 和 25.0 （15.0-35.0） vs. 41.0 （31.0-52.5） 分钟;（P < 0.001）]。实习生 ORB-ESD 、实习生 C-ESD 和专家 C-ESD 组在切除速度 （分别为 11.35 、 9.07 和 12.56 mm2/min） 、良好的视野暴露率 （96.7 、 80.7 和 93.4%） 和肌肉损伤率 （5.0 、 17.5 和 6.6%） 方面差异显著。然而，实习生 ORB-ESD 组和专家 C-ESD 组在这些指标上相似，并且所有三组在不良事件、整块切除、R0 切除和病理发生率方面都相似。累积总和表明，受训者 ORB-ESD 组的学习拐点早于受训者 C-ESD 组。结论 ORB-ESD 缩短了结直肠 ESD 手术时间，将受训者的效率提高到专家水平。ORB-ESD 可以缩短学习曲线，证明其广泛应用的合理性。