ESD training: A challenging path to excellence.

Area of Science:

• Gastroenterology
• Endoscopic Surgery
• Medical Training

Background:

• Endoscopic submucosal dissection (ESD) presents significant advantages over endoscopic mucosal resection (EMR) for treating early gastrointestinal neoplasia.
• The technique's challenging learning curve and inherent risks have limited its widespread adoption.

Purpose of the Study:

• To review current ESD training methodologies, focusing on essential components for achieving competence.
• To highlight the importance of animal models and expert supervision in ESD education.
• To emphasize specific training needs for colorectal ESD (CR-ESD) in Western countries.

Main Methods:

• Review of mentoring practices in Japan and other Asian countries.
• Analysis of training conditions for ESD program engagement and competence acquisition.
• Evaluation of ex vivo and in vivo animal models (porcine) for ESD practice.
• Specific focus on challenges and training requirements for colorectal ESD.

Main Results:

• ESD training typically involves theoretical study, observation of live cases, and initial interventions in animal models.
• Porcine models are commonly used for in vivo training, with ex vivo models offering a simpler alternative.
• In vivo training in live pigs is recommended before patient procedures.
• Colorectal ESD (CR-ESD) presents unique challenges, necessitating specialized training.

Conclusions:

• Comprehensive ESD training, incorporating animal models and mentorship, is vital for overcoming the technique's learning curve and risks.
• Proficiency in CR-ESD is particularly critical for Western healthcare systems where colorectal lesions are common.
• Standardized and rigorous training programs are essential for successful ESD implementation and patient outcomes.