Curriculum for endoscopic submucosal dissection training in Europe: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement

Published on Aug 30, 2019in Endoscopy7.341
· DOI :10.1055/A-0996-0912
Pedro Pimentel-Nunes27
Estimated H-index: 27
(University of Porto),
Mathieu Pioche17
Estimated H-index: 17
+ 15 AuthorsRaf Bisschops47
Estimated H-index: 47
(Katholieke Universiteit Leuven)
There is a need for well-organized comprehensive strategies to achieve good training in ESD. In this context, the European Society of Gastrointestinal Endoscopy (ESGE) have developed a European core curriculum for ESD practice across Europe with the aim of high quality ESD training. Advanced endoscopy diagnostic practice is advised before initiating ESD training. Proficiency in endoscopic mucosal resection (EMR) and adverse event management is recommended before starting ESD training ESGE discourages the starting of initial ESD training in humans. Practice on animal and/or ex vivo models is useful to gain the basic ESD skills. ESGE recommends performing at least 20 ESD procedures in these models before human practice, with the goal of at least eight en bloc complete resections in the last 10 training cases, with no perforation. ESGE recommends observation of experts performing ESD in tertiary referral centers. Performance of ESD in humans should start on carefully selected lesions, ideally small (  Endoscopists performing ESD should be able to correctly estimate the probability of performing a curative resection based on the characteristics of the lesion and should know the benefit/risk relationship of ESD when compared with other therapeutic alternatives. Endoscopists performing ESD should know how to interpret the histopathology findings of the ESD specimen, namely the criteria for low risk resection (“curative”), local risk resection, and high risk resection (“non-curative”), as well as their implications. ESD should be performed only in a setting where early and delayed complications can be managed adequately, namely with the possibility of admitting patients to a ward, and access to appropriate emergency surgical teams for the organ being treated with ESD.
📖 Papers frequently viewed together
7 Citations
39 Citations
10 Authors (Amit Bhatt, ..., Yutaka Saito)
20 Citations
#1Raf Bisschops (Katholieke Universiteit Leuven)H-Index: 47
#2Evelien DekkerH-Index: 65
Last. Thierry PonchonH-Index: 56
view all 8 authors...
6 CitationsSource
#1F. CatalanoH-Index: 10
#2Valentina Mengardo (University of Verona)H-Index: 4
Last. G. De Manzoni (University of Verona)H-Index: 25
view all 8 authors...
Endoscopic submucosal dissection (ESD) represents the standard of care for early gastric cancer in Eastern countries. Nevertheless, in the West, this procedure is not widespread. Aim of the study was to confirm the feasibility and the efficacy of ESD in the West. A total of 60 ESD were performed between January 2005 and December 2014 by two expert endoscopists. The analysis, based on a retrospective collected database, was conducted by dividing the study period in three subgroups. Clinical and t...
7 CitationsSource
#1Carl-Fredrik Rönnow (Lund University)H-Index: 4
#2Noriya UedoH-Index: 57
Last. Henrik Thorlacius (Lund University)H-Index: 50
view all 4 authors...
Background and study aims Endoscopic submucosal dissection (ESD) allows en bloc resection of large colorectal lesions but ESD experience is limited outside Asia. This study evaluated implementation of ESD in the treatment of colorectal neoplasia in a Western center. Patients and methods Three hundred and one cases of colorectal ESD (173 rectal and 128 colonic lesions) were retrospectively evaluated in terms of outcome, learning curve and complications. Results Median size was 4 cm (range 1 – 12....
13 CitationsSource
#1Mineo Iwatate (IMEC)H-Index: 10
#2Yasushi Sano (IMEC)H-Index: 35
Last. Yutaka SaitoH-Index: 72
view all 37 authors...
BACKGROUND AND AIM: The Japan narrow-band imaging (NBI) Expert Team (JNET) was organized to unify four previous magnifying NBI classifications (the Sano, Hiroshima, Showa, and Jikei classifications). The JNET working group created criteria (referred to as the NBI scale) for evaluation of vessel pattern (VP) and surface pattern (SP). We conducted a multicenter validation study of the NBI scale to develop the JNET classification of colorectal lesions. METHODS: Twenty-five expert JNET colonoscopist...
45 CitationsSource
#1Alexandru LupuH-Index: 3
#2Jérémie JacquesH-Index: 13
Last. Mathieu Pioche (French Institute of Health and Medical Research)H-Index: 17
view all 7 authors...
8 CitationsSource
#1Dane Christina Daoud (UdeM: Université de Montréal)H-Index: 1
#2Nicolas Suter (UdeM: Université de Montréal)H-Index: 2
Last. Daniel von Renteln (UdeM: Université de Montréal)H-Index: 18
view all 6 authors...
Comparing outcomes for endoscopic submucosal dissection between Eastern and Western countries: A systematic review and meta-analysis
24 CitationsSource
#1Lorenzo Fuccio (UNIBO: University of Bologna)H-Index: 34
#1Lorenzo Fuccio (UNIBO: University of Bologna)H-Index: 10
Last. Alessandro RepiciH-Index: 71
view all 7 authors...
In the last decade, endoscopic submucosal dissection (ESD) has become more popular in Asia and, more recently, also in Europe and North America, however the issue of quality control has never been raised. Therefore, there is an urgent need to identify possible quality indicators to monitor as part of internal audit process. This is particularly compelling, since the diffusion of ESD outside Asian, super-expert, high-volume, tertiary referral centers. In the current review, we raised the issue of...
4 CitationsSource
Last. Arjun D. Koch (EUR: Erasmus University Rotterdam)H-Index: 15
view all 6 authors...
IntroductionEndoscopic mucosal resection and endoscopic submucosal dissection are demanding procedures. This study aims to establish face, content and expert validity of the live porcine model in p...
12 CitationsSource
#1Alanna Ebigbo (Augsburg College)H-Index: 13
#2Andreas Probst (Augsburg College)H-Index: 15
Last. Helmut Messmann (Augsburg College)H-Index: 53
view all 4 authors...
Background and study aims The endoscopic submucosal dissection (ESD) of cancerous and precancerous lesions in the gastrointestinal (GI) tract is an effective but difficult-to-learn procedure, especially for Western endoscopists. We developed a step-up training protocol and evaluated its outcome on a single endoscopist using specific performance measures. Patients and methods The training protocol included a 12-month period of 50 observational and supervised ESD cases as well as 24 animal procedu...
8 CitationsSource
#1Mitsuru Esaki (Nihon University)H-Index: 13
#2Sho Suzuki (Nihon University)H-Index: 17
Last. Yoshihiro Ogawa (Kyushu University)H-Index: 115
view all 10 authors...
Endoscopic submucosal dissection (ESD) is a standard treatment for early gastric cancer. A new multi-functional ESD device was developed to achieve complete ESD with a single device. A metal plate attached to its distal sheath achieves better hemostasis during the procedure than the other needle-knife device, Flush Knife BT®, that has been conventionally used. The aim of this study was to compare the technical outcomes of ESD for early gastric cancer using the Splash M-Knife® with those using th...
12 CitationsSource
Cited By27
#1Tara Keihanian (UM: University of Miami)H-Index: 4
#2Mohamed Othman (BCM: Baylor College of Medicine)H-Index: 7
Endoscopic submucosal dissection (ESD) is a method of en-bloc resection of neoplastic colorectal lesions which is less invasive compared to surgical resection. Lesion stratification, architecture recognition and estimation of depth of invasion are crucial for patient selection. Expert endoscopists have integrated a variety of classification systems including Paris, lateral spreading tumor (LST), narrow band imaging (NBI), international colorectal endoscopic (NICE) and Japanese NBI expert team (J...
#1Gavin Johnson (UCL: University College London)H-Index: 15
#2George Webster (UCL: University College London)H-Index: 35
Last. Noor L. H. Bekkali (John Radcliffe Hospital)H-Index: 1
view all 26 authors...
The European Society of Gastrointestinal Endoscopy (ESGE) has recognized the need to formalize and enhance training in endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS). This manuscript represents the outcome of a formal Delphi process resulting in an official Position Statement of the ESGE and provides a framework to develop and maintain skills in ERCP and EUS. This curriculum is set out in terms of the prerequisites prior to training; recommended steps of tr...
#1Sohi Mistry (Case Western Reserve University)
#1Sohi Mistry (Case Western Reserve University)
Last. Amitabh Chak (University Hospitals of Cleveland)H-Index: 77
view all 7 authors...
Background null Endoscopic submucosal dissection (ESD) is technically challenging, has a longer learning curve and a greater complication rate than most new endoscopic procedures. Formal training and credentialing guidelines for ESD are currently lacking in the United States (US). null Aim null To survey ESD experts across the US to determine their learning process and obtain their opinion on how training and credentialing for ESD should develop. null Design null Anonymous electronic survey. nul...
#1Gloria Fernández-Esparrach (University of Barcelona)H-Index: 33
#2JC Marín-Gabriel (Complutense University of Madrid)H-Index: 2
view all 15 authors...
INTRODUCTION Endoscopic submucosal dissection (ESD) has become the treatment of choice for early gastric malignancies. In recent years, the ESD technique has been implemented in Western countries with increasing use. OBJECTIVES To describe the results of gastric ESD in a Western country with a low incidence of gastric cancer. PATIENTS AND METHODS The prospective national registry was conducted over 4 years in 23 hospitals, including 30 endoscopists. Epithelial and subepithelial lesions (SEL) qua...
#1Peter V. Draganov (UF: University of Florida)H-Index: 52
#2Hiroyuki Aihara (Brigham and Women's Hospital)H-Index: 18
Last. Dennis Yang (UF: University of Florida)H-Index: 21
view all 19 authors...
ABSTRACT Background and Aims Endoscopic submucosal dissection (ESD) in Asia has been shown to be superior to endoscopic mucosal resection (EMR) and surgery for the management of selected early gastrointestinal cancers. We aimed to evaluate technical outcomes of ESD in North America. Methods Multicenter prospective study on ESD across 10 centers in the United States and Canada between April 2016 to April 2020. End points included: rates of en-bloc resection, R0 resection, curative resection, adve...
2 CitationsSource
#1Gloria Fernández-Esparrach (University of Barcelona)H-Index: 33
#1Gloria Fernández Esparrach (University of Barcelona)H-Index: 2
Last. José Miguel Sanz Anquela (University of Alcalá)H-Index: 2
view all 13 authors...
Resumen Este documento de posicionamiento, auspiciado por la Asociacion Espanola de Gastroenterologia, la Sociedad Espanola de Endoscopia Digestiva y la Sociedad Espanola de Anatomia Patologica tiene como objetivo establecer recomendaciones para realizar una endoscopia digestiva (EDA) de calidad en la deteccion y vigilancia de lesiones precursoras de cancer gastrico (LPCG) en poblaciones con incidencia baja, como la espanola. Para establecer la calidad de la evidencia y los niveles de recomendac...
#1Gloria Fernández-Esparrach (University of Barcelona)H-Index: 33
#2José Carlos Marín-Gabriel (Complutense University of Madrid)H-Index: 5
Last. Leticia Moreira (University of Barcelona)H-Index: 22
view all 13 authors...
This position paper, sponsored by the Asociacion Espanola de Gastroenterologia [Spanish Association of Gastroenterology], the Sociedad Espanola de Endoscopia Digestiva [Spanish Gastrointestinal Endoscopy Society] and the Sociedad Espanola de Anatomia Patologica [Spanish Anatomical Pathology Society], aims to establish recommendations for performing an high quality upper gastrointestinal endoscopy for the screening of gastric cancer precursor lesions (GCPL) in low-incidence populations, such as t...
#4Do Hoon Kim (UOU: University of Ulsan)H-Index: 29
#6Jeong Hoon Lee (UOU: University of Ulsan)H-Index: 29
#1Hiroyuki Aihara (Brigham and Women's Hospital)H-Index: 18
#2Sunil Dacha (Houston Methodist Hospital)H-Index: 3
Last. Mihir S. Wagh (University of Colorado Denver)H-Index: 25
view all 13 authors...
1 CitationsSource
#1Pradeep Bhandari (University of Portsmouth)H-Index: 41
#2Gaius Longcroft-Wheaton (University of Portsmouth)H-Index: 16
Last. Mário Dinis-Ribeiro (University of Porto)H-Index: 57
view all 20 authors...
BACKGROUND One of the aims of the European Society of Gastrointestinal Endoscopy (ESGE) is to encourage high quality endoscopic research at a European level. In 2016, the ESGE research committee published a set of research priorities. As endoscopic research is flourishing, we aimed to review the literature and determine whether endoscopic research over the last 4 years had managed to address any of our previously published priorities. METHODS As the previously published priorities were grouped u...