Untutored training pathway to achieve competence in esophagogastric endoscopic submucosal dissection in a Western center

Abstract

Background and AimsEndoscopic submucosal dissection (ESD) has a long learning curve. We aimed to assess the efficacy of an ESD unsupervised training model for experienced endoscopists. MethodsStepwise training included visit to high-volume center, unsupervised training on an ex-vivo porcine model and in-vivo human upper GI cases with anatomical progression. Performance measures: en-bloc resection, R0 resection, complication rates and operative time. ResultsFollowing observation of 30 esophago-gastric ESDs and 15 un-tutored ex-vivo ESDs, five human cases of distal gastric ESDs were performed, followed by 55 unselected esophago-gastric cases. En-bloc and R0 resection rates were 93.0% and 80.7%, respectively. Operative time was 14.0 min/cm2 in stomach and 25.1 min/cm2 in esophagus, with evidence of learning curve for esophageal ESDs (first block 30.26 vs second block 14.81 min/cm2, p=0.01). ConclusionsUn-tutored training for esophago-gastric ESD is feasible and allows endoscopists, experienced in therapeutic endoscopy, to achieve the required standards towards competency.