How to master endoscopic submucosal dissection in the USA

Abstract

Endoscopic submucosal dissection (ESD) is an established technique for the endoscopic therapy of dysplastic and early cancerous lesions throughout the gastrointestinal tract. The procedure requires both a sophisticated knowledge for lesion characterization and high-level endoscopic skills. As a result, the learning curve is very steep and, in Japan, it takes years to gain proficiency under the traditional Master-Apprentice teaching model. At present, as a result of multiple limitations, this training model is not applicable to the USA. Nevertheless, a unique, multipronged, stepwise approach has emerged as a viable pathway to train US endoscopists in ESD. Although this approach deserves refinement, it has already led to the expansion of ESD in the USA, has contributed to the widening of the indications for ESD, and has further developed ESD techniques. Multiple challenges remain, but they can be overcome by active collaboration between Japanese and US endoscopists and professional societies. The robust interest in ESD in the USA has drawn industry attention with a few innovations already coming to fruition and many more in development.

Pathologic evaluation of endoscopically resected non-ampullary duodenal lesions: a single center experience

“…n=166 duodenal ERs in Pérez-Cuadrado-Robles et al's study) are being published from specialized referral centers (25,26). The main reason for this is that, similar to other sites of the gastrointestinal tract, the western experience with duodenal ESD and EMR was limited compared to the Far East (22)(23)(24)(27)(28)(29)(30)(31)(32), due to flat learning curve of these techniques and lack of training facilities for the endoscopists in the west (17,(33)(34)(35). In fact, as reported by Yamamoto et al, even in Japan where these procedures were developed and mastered, duodenal ESDs are performed in only a few institutions, due to the high risk of complications (19).…”

Current state of education and training for endoscopic submucosal dissection: Translating strategy and success to the USA

“…I N JAPAN AND other East Asian countries, ESD training follows a conventional master-apprentice model, with proficiency of technique and procedure-associated knowledge gained through a step-wise introduction to the procedure. 9,10 After appropriate, formalized didactic education, observation of the procedure by expert endoscopists for an often, predetermined amount of time is required. Next, trainees may begin exposure with animal models or begin to assist that expert before graduating to carrying out only parts of the procedure under direct supervision.…”

Gaining traction: pulley-ing your weight during endoscopic submucosal dissection

“…As such, even in Japan, where ESD was initially developed, training still requires years before trainees are capable of performing their own procedures safely and proficiently. 15 Effective countertraction methods to improve visualization of the dissection plane should intuitively improve the safety and reduce the technical complexity of the procedure, which should facilitate the adoption and dissemination of ESD. Is the suture pulley method the answer we have been waiting for?…”