Training in endoscopic submucosal dissection.

Area of Science:

• Gastroenterology
• Endoscopic Surgery
• Medical Training

Background:

• Endoscopic submucosal dissection (ESD) is a superior technique for early gastrointestinal neoplastic lesions, offering higher en-bloc resection rates and lower recurrence than endoscopic mucosal resection (EMR).
• Despite its benefits, ESD is technically demanding, requiring advanced endoscopic skills and leading to longer procedure times and increased complication rates.
• A recognized need exists for structured ESD training to enhance trainee competence and minimize risks.

Purpose of the Study:

• To address the need for standardized ESD training, particularly for Western physicians.
• To propose a novel training algorithm tailored to the Western medical context.
• To improve the safety and efficacy of ESD procedures globally.

Main Methods:

• Review of existing ESD training algorithms, primarily from Japan.
• Identification of differences between Japanese and Western ESD practices (e.g., mentor availability, pathology, devices, trainee background).
• Proposal of a Western-centric training algorithm integrating hands-on courses, animal models, and expert center visits.

Main Results:

• Existing Japanese ESD training algorithms are not directly transferable to Western countries.
• Over 30 supervised gastric ESD procedures are suggested as a benchmark for technical proficiency in Japan.
• A consensus exists on the importance of preceptor training programs for global ESD adoption.

Conclusions:

• A tailored training algorithm is crucial for effective ESD adoption in the West.
• The proposed algorithm combines diverse training modalities to bridge the gap in current ESD education.
• Further development of preceptor training programs is essential for worldwide dissemination of ESD expertise.