Research & Innovation
Publications
Clinical Endoscopic Submucosal Dissection of Trainees Tutored by Experts-ESGE Endorsed Courses and Live Endoscopic Events 2011-2015
PMU Authors
Daniel Neureiter, Tobias Kiesslich, Andrej Wagner, Josef Holzinger, Frieder Berr
All Authors
, Daniel Neureiter, Naohisa Yahagi, Tsuneo Oyama, Takashi Toyonaga, Tobias Kiesslich, Andrej Wagner, Franz Ludwig Dumoulin, Alexander Ziachehabi, Hans-Peter Allgaier, Michael Anzinger, Gerhard Kleber, Hans Seifert, Alberto Herreros De Tejada, Ingo Steinbruck, Barbara Tribl, Alberto Tringali, Josef Holzinger, Alanna Ebigbo, Joao Santos-Antunes, Juergen Hochberger, Sergey V. Kantsevoy, Mathieu Pioche, Thierry Ponchon, Frieder Berr
Journal association
Journal of Clinical Medicine
Abstract
Background/Objectives: Endoscopic submucosal dissection (ESD) is a state-of-the-art en bloc resection for early gastro-intestinal cancers and precursors developed and validated in Japan. Western expertise with this complex technique remains limited. Tutored training might be optimal for patients and ESD learning. We established ESD tutoring courses led by experienced Japanese experts to provide (i) optimal long-term curative outcomes and low complication rates for patients and (ii) hands-on training on difficult lesions for European endoscopists under direct expert supervision. Methods: Prospective data from 2011 to 2015 (follow-up to 12/2024) were analyzed. A total of 118 neoplasms (50% HGIEN and cancer) in 101 patients (median age 68 [37-91] years; 38% with significant comorbidities) were treated with expert or tutored ESD. Japanese experts performed 28 ESDs, while 22 trained beginners conducted 90 supervised procedures on difficult lesions during 5 live and 20 tutoring events (1-4 days each). Results: Analysis of the complete data showed curative and en bloc resection rates of 88% and 95%, respectively, with no recurrence after R0 resections during a median follow-up of 9.8 [1.5-14.9] years. Long-term survival remained recurrence-free after endoscopic resection of 3 recurrent adenomas (at R1/Rx) and curative surgery/2nd ESD for 5 non-curative ESDs. Adverse events occurred in 9.3% without emergency surgery or 30-day mortality. Comparing expert-only vs. tutored ESD procedures, beginners correctly applied curative ESD indications in 94% of 118 neoplasms. Experts resected larger lesions (22 cm2) at a rate of 9.3 cm2/h in 121 min. Tutored beginners achieved a 75% [25-100] self-completion rate on 33% smaller lesions in 112 min. Conclusions: ESD tutoring courses led by Japanese experts ensure excellent patient outcomes and standardized procedural training. This model may foster professional ESD performance across European referral centers.
Keywords
ESD clinical training, ESD indication, ESD tutoring outcome, colorectal ESD, early GI cancer