Training for complex endoscopic procedures: how to incorporate endoscopic submucosal dissection skills in the West?

Draganov, Peter V.; Coman, Roxana M.; Gotoda, Takuji

doi:10.1586/17474124.2014.864552

Cited by 52 publications

(42 citation statements)

References 7 publications

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“…The Japanese model is difficult to apply for Western endoscopists, where the availability of expert ESD mentors and incidence of EGC in the West is less than in East Asia . Ex vivo and in vivo porcine models can function as a stepping stone, and training on such models may lead to significant improvements in carrying out ESD .…”

Section: Western Endoscopic Submucosal Dissection Trainingmentioning

confidence: 99%

Endoscopic submucosal dissection in the West: Current status and future directions

Michael

Bourke

2017

Digestive Endoscopy

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Endoscopic submucosal dissection (ESD) was first conceptually described almost 30 years ago in Japan and is now widely practiced throughout East Asia. ESD expands the boundaries of endoscopic resection (ER) by allowing en bloc resection of large early neoplastic lesions within the gastrointestinal tract (GIT). This offers advantages over other ER techniques by facilitating definitive histological staging and curative treatment of early cancer in selected cases. Indeed, the experience of ESD in Eastern countries is significant, and excellent outcomes from high-volume centers are reported. The potential benefits of ESD are recognized by Western endoscopists, but its adoption has been limited. A number of factors contribute to this, including epidemiological differences in GIT neoplasia between Western and Eastern populations and limitations in training opportunities. In this review, we discuss the role of ESD, its current status and the future in Western endoscopic practice.

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Section: Western Endoscopic Submucosal Dissection Trainingmentioning

confidence: 99%

Endoscopic submucosal dissection in the West: Current status and future directions

Michael

Bourke

2017

Digestive Endoscopy

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“…A Japanese study reports that the experiencing of at least 30 supervised cases is required to gain an early proficiency in this technique (29). However, it is admitted that the Japanese algorithm for learning ESD cannot be directly implemented in the West due to cultural differences in teaching models (30), not to mention a lower case load (8). Small patient volumes in Western countries and the technical difficulties of ESD are arguments for cooperation and common solutions for training programs as well as training centers on a national and even multi-national level.…”

Section: Discussionmentioning

confidence: 99%

Implementation of Endoscopic Submucosal Dissection for Gastric Lesions in Norway

Rushfeldt

Aabakken

2015

Scand J Surg

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Background and aims: endoscopic submucosal dissection is a minimal invasive method for an en bloc resection of dysplasia or early cancer in the stomach. It was developed in Japan in the 1990s, but thus far has not been widely adopted in western countries. the aim of this study is to report from the introductory phase of gastric endoscopic submucosal dissection in a small-volume scandinavian center.Material and Methods: the 15 first patients operated on with endoscopic submucosal dissection in the stomach at the university Hospital of north norway were consecutively registered in a prospective database and evaluated as a quality assurance study. the indications for the procedures were diagnostic or therapeutic.Results: three patients had benign lesions, three had low-grade dysplasia, five had high-grade dysplasia, two had neuroendocrine tumors, and two had early gastric cancers (t1b). the r0 resection rate was 83%. one neuroendocrine tumor was directed to surgery. no recurrences have been detected after the median of 6 months, and with the exception of one delayed bleeding being treated endoscopically, no serious complications occurred. two perforations were perioperatively closed with clips.Conclusion: this is the first report on gastric endoscopic submucosal dissection in scandinavia. preliminary results from an introductory phase indicate that endoscopic submucosal dissection for dysplasia or early gastric cancer may be conducted safely and with acceptable results even in a small-volume center, assuming that surgeons and gastroenterologists in a region direct cases to one individual who can learn this skill.

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“…At present, there is no standardized approach for ESD training in the USA. Nevertheless, a commonly followed pathway to gain training in ESD has emerged and was followed by two of the authors of this article (PVD and DY) . This stepwise approach is outlined in Figure .…”

Section: Methodsmentioning

confidence: 99%

“…As early gastric cancer is uncommon in the USA, suitable lesions to begin the practice of ESD are typically located in the rectum. The feasibility of such an approach and the utility of ESD have been shown in multiple studies …”

Section: Methodsmentioning

confidence: 99%

How to master endoscopic submucosal dissection in the USA

Kotzev

Yang

Draganov

2018

Digestive Endoscopy

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Endoscopic submucosal dissection (ESD) is an established technique for the endoscopic therapy of dysplastic and early cancerous lesions throughout the gastrointestinal tract. The procedure requires both a sophisticated knowledge for lesion characterization and high-level endoscopic skills. As a result, the learning curve is very steep and, in Japan, it takes years to gain proficiency under the traditional Master-Apprentice teaching model. At present, as a result of multiple limitations, this training model is not applicable to the USA. Nevertheless, a unique, multipronged, stepwise approach has emerged as a viable pathway to train US endoscopists in ESD. Although this approach deserves refinement, it has already led to the expansion of ESD in the USA, has contributed to the widening of the indications for ESD, and has further developed ESD techniques. Multiple challenges remain, but they can be overcome by active collaboration between Japanese and US endoscopists and professional societies. The robust interest in ESD in the USA has drawn industry attention with a few innovations already coming to fruition and many more in development.

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Training for complex endoscopic procedures: how to incorporate endoscopic submucosal dissection skills in the West?

Cited by 52 publications

References 7 publications

Endoscopic submucosal dissection in the West: Current status and future directions

Endoscopic submucosal dissection in the West: Current status and future directions

Implementation of Endoscopic Submucosal Dissection for Gastric Lesions in Norway

How to master endoscopic submucosal dissection in the USA

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