Navigating the learning landscape: Comprehensive training in third space endoscopy - training, techniques, and...

Area of Science:

• Gastroenterology and Endoscopy
• Surgical Education

Background:

• Third space endoscopy (TSE) encompasses advanced endoscopic procedures such as endoscopic submucosal dissection (ESD), peroral endoscopic myotomy (POEM), and submucosal tunneling endoscopic resections (STER).
• Despite increasing adoption, standardized training curricula and evidence-based protocols for TSE are notably absent.
• This gap necessitates a structured approach to developing the required technical proficiency and cognitive skills for endoscopists.

Purpose of the Study:

• To review and propose effective training methodologies for third space endoscopy (TSE).
• To identify essential cognitive skills and technical proficiencies for performing TSE procedures, with a focus on POEM.
• To outline practical recommendations for a comprehensive TSE training program.

Main Methods:

• Literature review focusing on training methods, simulators, preclinical models, and clinical experience for TSE.
• Analysis of existing evidence regarding procedural numbers for skill acquisition and the role of mentorship.
• Synthesis of recommendations for theoretical knowledge and technical skill development.

Main Results:

• A step-up training approach is recommended, beginning with ex-vivo models and simulators (mechanical and virtual reality).
• Preclinical training using ex-vivo and live animal models is crucial for preparing trainees.
• Approximately 20-40 supervised cases are suggested to reach an initial plateau in performance, with clinical training duration varying by prior experience.

Conclusions:

• Existing evidence supports the use of preclinical models and specialized training programs for TSE.
• A structured, step-up training approach is vital for ensuring safe and effective TSE procedures.
• Mentorship programs and adverse event management training are critical components of TSE education.