Endoscopic Submucosal Dissection (ESD) Training in the West: Where Do We Stand?

Abstract

Introduction: ESD has been a widely accepted method for the en-bloc resection of superficial gastric and colorectal cancers in Japan. ESD experience is limited in the United States. Training systems are being proposed to promote a permeation of ESD techniques in the West. We conducted a survey questionnaire to attendees of a University-sponsored ESD training course held by experts of ESD. The purpose of this study was to assess the current endoscopists training in the US to perform ESD. This group was chosen because of their expressed interest in ESD. We plan to gain insight into the past, present and future training patterns of these Gastroenterologists pursuing and performing ESD. Methods: An IRB approved online anonymous survey was distributed to participants of an annual ESD course held from 2014-2016. Survey questions were utilized to assess and evaluate participants' level of experience with ESD techniques, equipment, practice and planned training. Results: 34 of 86 course attendees completed our questionnaire. 93.9% were male, the majority being 36-50 years old (66.7%) and foreign medical graduates out numbering US graduates 18 to 15 (54.5%). Gastroenterology/surgical training of 97% was affirmed, with 72.7% having completed a 4th year in advanced endoscopy training year. ERCP and EUS are being performed by these endoscopists, 81.8% and 78.8% respectively. The majority surveyed are affiliated with academic medical centers (66.7%). Most participants had little to no experience with ESD in humans (90.9%) but rather ESD didactic learning. We found that participants that actually perform ESD in humans as the lead endoscopist was 6.1% with 3% having supervision to perform ESD in humans. Perceptions on ESD gaining acceptance as a standard of care in the United States varied among respondents. A third surveyed that It will not gain acceptance as routinely performed “standard of care” procedure (10, 30.3%), and a slightly greater percentage feeling it will gain acceptance (13, 39.4%) and still many not sure on the future of ESD (10, 30.3%). Conclusion: The primary motivation for attending our course included interest for exposure and consideration to pursue further training. The current training system is not efficient because the majority of attendees are still not performing ESD after attending these courses. Mentorship and guidance may further ESD training in the US.