Building Expertise in Endoscopic Submucosal Dissection: Insights From the French Training Curriculum

Endoscopic submucosal dissection requires advanced skills and extensive training, with a particularly steep learning curve for colonic endoscopic submucosal dissection. Since 2021, the French Society of Digestive Endoscopy has implemented a structured curriculum based on European Society of Gastrointestinal Endoscopy endoscopic submucosal dissection curriculum. This study aimed to assess its effectiveness and predictive factors of competency.

Participants enrolled in the first three French Society of Digestive Endoscopy endoscopic submucosal dissection training years (2021-2023) were included. After online education and a standardized hands-on training week, trainees documented every endoscopic submucosal dissection performed at their center. A successful endoscopic submucosal dissection was defined as an en bloc R0 resection without surgery for a procedure-related adverse event. Competency thresholds were set at >90% R0 resection and <1% surgery for complications.

Forty-five trainees performed 2051 endoscopic submucosal dissections. The median age was 36 years and 70.7% were men, with 6 years of endoscopy experience (interquartile range, 4-10 years). Lesion were mainly colorectal (42.9% rectal, 42.7% colonic) with a median size of 45 mm (interquartile range, 34-60 mm). En bloc and R0 resections were achieved in 93.6% and 85.8% of cases, respectively. Surgery for complications was required in 0.9%. The overall success rate was 92.7%. By study end, 80% of students reached competency, requiring a median of 21 endoscopic submucosal dissections. Predictive factors of success included lesion location (rectum > colon). Age (hazard ratio, 0.92; 95% confidence interval, 0.86-0.99; P = .03) and prior experience (hazard ratio, 0.91; 95% confidence interval, 0.84-0.99; P = .03) were inversely correlated with competency. Training in a high-volume endoscopic submucosal dissection center (>100 endoscopic submucosal dissections/year) accelerated competency acquisition (P = .008).

This first evaluation of the European Society of Gastrointestinal Endoscopy/French Society of Digestive Endoscopy endoscopic submucosal dissection curriculum in France demonstrates that endoscopic submucosal dissection competency is achievable after structured training, even without extensive prior endoscopy experience.