Current status and trend in training for endoscopic submucosal dissection: A nationwide survey in Korea

Abstract

Background: Although endoscopic submucosal dissection (ESD) is widely used, the current status and trend in its training have yet to be fully evaluated. We aimed to investigate how ESD endoscopists have been trained in actual clinical practice.

Methods: Endoscopists aged <45 years who have completed a gastroenterology fellowship or were currently in a fellowship for ≥2 years were included. We conducted a nationwide survey on the ESD training experiences of these endoscopists.

Results: Among 79 young Korean endoscopists invited to participate in the survey, 68 (86.1%) trained in 24 major hospitals responded to the questionnaire. Twenty, 25, and 23 participants belonged to the second-year fellow, <5 years after training, and ≥5 years after training groups, respectively. Sixty-nine percent of the participants observed ≥50 ESD cases before starting ESD under supervision by an expert endoscopist. Additionally, 22% experienced ≥20 supervised ESDs during the training period. The proportion of the participants who underwent a hands-on course differed among the groups (≥5 years after training, 13.0%; <5 years after training, 40.0%; and second-year fellow, 50.0%; P = 0.027). ESD under supervision, observation, and hands-on course were the preferred methods for learning ESD (91.1%, 80.9%, and 35.3%, respectively). Overall, 42.6% of the participants were satisfied with their training program. More experience in supervised ESD (≥20 cases) was associated with an increased satisfaction (odds ratio, 6.65; 95% confidence interval, 1.62-36.31).

Conclusions: Observation and performance of ESD under the supervision of an expert endoscopist are the primary methods for learning ESD. Hands-on course program has been used more frequently in recent years.

Fig 1. Satisfaction score for the training course in the hospital.

(A) Score for the systematic training. The mean scores were 2.8, 3.3, and 3.1 in the second-year fellow group, <5 years after fellowship training group, and ≥5 years after fellowship training group, respectively (P = 0.401). (B) Score for the overall satisfaction. The mean scores were 3.2, 3.6, and 3.0 in the second-year fellow group, <5 years after fellowship training group, and ≥5 years after fellowship training group, respectively (P = 0.663). ^aOne participant in the second-year fellow group did not respond to these questions.

Fig 2. Optimal number of observations and procedures under supervision for learning ESD.

(A) Optimal number of observations before starting ESD under supervision. (B) Optimal number of procedures under supervision to achieve competency. ^aOne participant in the ≥5 years after fellowship training group did not respond to these questions. ESD, endoscopic submucosal dissection.