A Nationwide Survey of Training Pathways and Practice Trends of Endoscopic Submucosal Dissection in Canada

Abstract

Background: Endoscopic submucosal dissection (ESD) has become an established standard for endoscopic removal of large gastrointestinal (GI) lesions and early GI malignancies. However, ESD is technically challenging and requires significant health care infrastructure. As such, its adoption in Canada has been relatively slow. The practice of ESD across Canada remains unclear. Our study aimed to provide a descriptive overview of training pathways and practice trends of ESD in Canada.

Methods: Current ESD practitioners across Canada were identified and invited to participate in an anonymous cross-sectional survey.

Results: Twenty-seven ESD practitioners were identified; survey response rate was 74%. Respondents were from 15 different institutions. All practitioners underwent international ESD training of some type. Fifty per cent pursued long-term ESD training programs. Ninety-five per cent attended short-term training courses. Sixty per cent and 40% performed hands-on live human upper and lower GI ESD, respectively, before independent practice. In practice, 70% saw an increase per year in number of procedures performed from 2015 to 2019. Sixty per cent were dissatisfied with their institution's health care infrastructure to support ESD. Thirty-five per cent perceived their institution as supportive of expanding the practice of ESD.

Conclusions: Several challenges exist to the adoption of ESD in Canada. Training pathways are variable, with no set standards. In practice, practitioners express dissatisfaction with access to necessary infrastructure and feel poorly supported in expanding the practice of ESD. As ESD is increasingly the accepted standard for the treatment of many neoplastic GI lesions, greater collaboration between practitioners and institutions is crucial to standardize training and ensure patient access.

Keywords: Endoscopic practice; Endoscopic submucosal dissection; Luminal endoscopy.

Figure 1.

Respondents comfort level with performing ESD.

Figure 2.

Year of commencement of ESD practice.

Figure 3.

Approximate number of ESD procedures performed by respondents per year.

Figure 4.

Referral providers awareness of ESD availability and indications.

Figure 5.

Ease of securing resources for ESD.

Figure 6.

Overall satisfaction with remuneration and infrastructure for ESD.

Figure 7.

Perceived supportiveness of institution in expanding practice of ESD.