Video-based supervision for training of endoscopic submucosal dissection.

Area of Science:

• Gastroenterology
• Surgical Education
• Medical Technology

Background:

• Endoscopic submucosal dissection (ESD) adoption in Western countries is hindered by the procedure's learning curve.
• Expert guidance is crucial for mastering ESD, but Western experts are scarce.
• Remote video-based supervision offers a practical solution for ESD training.

Purpose of the Study:

• To evaluate the effectiveness of video-based remote evaluation in supervising endoscopic submucosal dissection (ESD) training for Western endoscopists.

Main Methods:

• Two Western endoscopists underwent ESD training in a porcine model, performing procedures bi-weekly.
• Competency was defined by consistent en bloc resection of a 3-cm area within 30 minutes without perforation.
• A Japanese ESD expert provided remote video analysis and feedback after each session.

Main Results:

• Competency was achieved by endoscopist 1 at 23 procedures and endoscopist 2 at 25 procedures.
• No significant difference in skill improvement was observed between the two trainees.
• One trainee successfully performed eight patient ESD procedures with curative resection and no complications.

Conclusions:

• A structured ESD training program incorporating remote expert guidance is effective for acquiring ESD skills.
• This approach prepares endoscopists for performing ESD in clinical settings.
• Video-based remote supervision is a valuable tool for ESD education in Western countries.