ESD clinical tutoring

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ESD Tutoring Course concept

There now is a supply network of ESD centers (>54 centers) across Europe on competent (>30 ESD) or professional level (>150 ESD), and 29 centers started ESD (Fig. 1B) – and at least 11 additional uninvolved ESD centers that have published ESD series in Europe. Implementation of ESD – mainly in elderly often comorbid patients - was achieved with low risk (ref 1). There is no longer a need for training in live animals with experts to implement clinical ESD by unsupervised self-learning (ref 2). Now, European guidelines recommend to start clinical ESD (first 10 – 20 procedures) under supervision by an ESD expert (mentor).

Published ESD series from Europe report similar en-bloc resection rates as in Japan (~85% vs ≥90%). However, curative resection rates have been on the average 15-20% lower in Europe than in Japan (60 – 70% vs. ~≥85%) (ref 2-4). Major factor was ESD on submucosal-invasive early cancer lesions (out of ESD indication) (ref 2). In conclusion, an effort is needed in Europe to improve the professional level of ESD centers (in phase III and IV, Fig. 1A) for reliable cure of patients (curative resection rate → ~ 85%).

Best format is a clinical training course for European ESD endoscopists tutored by International ESD experts:

  1. teaching assistance given by top Japanese expert to a local ESD endoscopist, as well as
  2. passive attendance of 4 ESD endoscopists during Endoscopic diagnosis and ESD procedure.

Involvement of an ESD endoscopist in the teaching assistance as well as safe, timely and curative performance of ESD under supervision of the Japanese expert remains in the responsibility of the attending in-hospital ESD endoscopist. We have five years experience with this „Clinical ESD Tutoring“ format with excellent outcome (ref 5).

Report of the first ESD tutoring course in Munich 2019
Fig. 4 (ref. 2) Distribution of interventional endoscopy referral centers participating in the Clinical ESD Tutorings [blue flags](17 courses, duration 1-4 days; 51 participants [most repeatedly] from 16 countries). Additional participants from Jerusalem, Cairo, Auckland. Created with www.google.com/maps.

Aims for the

  • COURSE (2 days), training of European ESD endoscopists (in phase III and IV of Fig. 1) to enhance ESD performance on professional level - both for a) endoscopic indication i.e. prediction of pT category (major factor!) and b) endosurgical skills on challenging lesions.
  • UPDATE (3rd day), training of additional European screening endoscopists for
    1. making endoscopic differential indication (endoscopic resection vs. surgery & lymphadenectomy)
    2. understanding for the feasibility of endoscopic en-bloc resection (ESD) of early cancer.

Reference #5
Wagner A, Neureiter D, Ziachehabi A, Kiesslich T, Allgaier HP, Kleber G, et al. Endoscopic submucosal dissection by trainees tutored by Japanese experts: short-term results (abstr.). Endoscopy. 2018;50:S98.