How to establish endoscopic submucosal dissection in Western countries

Abstract

Endoscopic submucosal dissection (ESD) has been invented in Japan to provide resection for cure of early cancer in the gastrointestinal tract. Professional level of ESD requires excellent staging of early neoplasias with image enhanced endoscopy (IEE) to make correct indications for ESD, and high skills in endoscopic electrosurgical dissection. In Japan, endodiagnostic and endosurgical excellence spread through personal tutoring of skilled endoscopists by the inventors and experts in IEE and ESD. To translocate this expertise to other continents must overcome two fundamental obstacles: (1) inadequate expectations as to the complexity of IEE and ESD; and (2) lack of suitable lesions and master-mentors for ESD trainees. Leading endoscopic mucosal resection-proficient endoscopists must pioneer themselves through the long learning curve to proficient ESD experts. Major referral centers for ESD must arise in Western countries on comparable professional level as in Japan. In the second stage, the upcoming Western experts must commit themselves to teach skilled endoscopists from other referral centers, in order to spread ESD in Western countries. Respect for patients with early gastrointestinal cancer asks for best efforts to learn endoscopic categorization of early neoplasias and skills for ESD based on sustained cooperation with the masters in Japan. The strategy is discussed here.

Keywords: Early cancer; Endoscopic submucosal dissection; Endoscopic submucosal dissection clinical tutoring; Endoscopic submucosal dissection complications; Endoscopic submucosal dissection learning curve; Endoscopic submucosal dissection techniques; Endoscopic submucosal dissection training; Gastrointestinal neoplasias.

Figure 1

Strategy how to learn and establish endoscopic submucosal dissection in the west. ESD: Endoscopic submucosal dissection.

Figure 2

Distribution of reference centers with interventional endoscopists participating in the seven experimental endoscopic submucosal dissection workshops [red flags, n = 110, (30 two times)] and in the Clinical endoscopic submucosal dissection-Tutorings (blue flags, n = 51, repeatedly). Additional participants in workshops and clinical tutoring from Jerusalem, Amman and Cairo, respectively. Created with www.google.com/maps.