Clinical Endoscopic Submucosal Dissection of Trainees Tutored by Experts—ESGE Endorsed Courses and Live Endoscopic Events 2011–2015

TL;DR

Expert-led training in endoscopic submucosal dissection (ESD) for early gastrointestinal cancers in Europe achieved high success rates and low complications, even when performed by trainees.

Contribution

Demonstrates the effectiveness of expert-tutored ESD training in Europe for achieving curative outcomes and standardizing complex procedures.

Findings

Curative and en bloc resection rates were 88% and 95%, with no recurrence after R0 resections during a median 9.8-year follow-up.

Adverse events occurred in 9.3% of cases, with no emergency surgery or 30-day mortality.

Trainees correctly applied curative ESD indications in 94% of cases and achieved a 75% self-completion rate on smaller lesions.

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.

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