Endoscopic submucosal dissection: a country dissemination experience and outcomes

Area of Science:

• Gastroenterology
• Endoscopy
• Surgical Techniques

Background:

• Endoscopic submucosal dissection (ESD) use is increasing in Western countries.
• Variations in ESD training and outcomes exist across regions.
• Portugal's specific ESD training model and outcomes require detailed reporting.

Purpose of the Study:

• To describe the training model for endoscopic submucosal dissection (ESD) in Portugal.
• To report on the implementation of ESD procedures in Portuguese centers.
• To evaluate the outcomes and challenges associated with ESD in Portugal.

Main Methods:

• A survey was distributed to nine endoscopists trained in ESD in Portugal.
• The survey covered training duration, ESD outcomes, and center implementation details.
• Data on procedure volume, resection rates, and complications were collected.

Main Results:

• Median ESD training involved 6 months of assistance in high-volume centers, supplemented by hands-on courses.
• A total of 1229 ESDs were performed, primarily in gastric lesions, with high R0 resection (92%) and curative resection (87%) rates.
• The median perforation rate was 0.89%, with primary implementation barriers being lack of mentoring and expertise for complex lesions.

Conclusions:

• Hands-on courses and high-volume center training provide adequate initial ESD competence, aligning with European guidelines.
• Mentorship is critical for technical progression and overcoming adoption barriers.
• Structured training programs and simulator-based practice are recommended to enhance ESD implementation.