TY - JOUR
T1 - Clinical Endoscopic Submucosal Dissection of Trainees Tutored by Experts-ESGE Endorsed Courses and Live Endoscopic Events 2011-2015
AU - ESD Tutoring Training Grp
AU - Neureiter, Daniel
AU - Yahagi, Naohisa
AU - Oyama, Tsuneo
AU - Toyonaga, Takashi
AU - Kiesslich, Tobias
AU - Wagner, Andrej
AU - Dumoulin, Franz Ludwig
AU - Ziachehabi, Alexander
AU - Allgaier, Hans-Peter
AU - Anzinger, Michael
AU - Kleber, Gerhard
AU - Seifert, Hans
AU - Herreros De Tejada, Alberto
AU - Steinbruck, Ingo
AU - Tribl, Barbara
AU - Tringali, Alberto
AU - Holzinger, Josef
AU - Ebigbo, Alanna
AU - Santos-Antunes, Joao
AU - Hochberger, Juergen
AU - Kantsevoy, Sergey V.
AU - Pioche, Mathieu
AU - Ponchon, Thierry
AU - Berr, Frieder
N1 - Neureiter: Institute of Pathology, University Hospital, Paracelsus Medical University, 5020 Salzburg, Austria; Kiesslich, Berr, Wagner: Department of Medicine I, University Hospital, Paracelsus Medical University, 5020 Salzburg, Austria; Kiesslich, Berr:
Center for Physiology, Pathophysiology and Biophysics, Institute of Physiology and Pathophysiology, Paracelsus Medical University, 5020 Salzburg, Austria; Holzinger: ivision Endoscopy, Department of Surgery, University Hospital, Paracelsus Medical University, 5020 Salzburg, Austria;
Lehr-KH Ordensklinikum Linz—Elisabethinen, 4020 Linz, Austria; Klinikum SOB, 83435 Bad Reichenhall, Germany
PY - 2026/1/14
Y1 - 2026/1/14
N2 - 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.
AB - 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.
KW - ESD clinical training
KW - ESD indication
KW - ESD tutoring outcome
KW - colorectal ESD
KW - early GI cancer
UR - https://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=pmu_pure&SrcAuth=WosAPI&KeyUT=WOS:001670728100001&DestLinkType=FullRecord&DestApp=WOS_CPL
U2 - 10.3390/jcm15020675
DO - 10.3390/jcm15020675
M3 - Original Article
C2 - 41598613
SN - 2077-0383
VL - 15
JO - Journal of Clinical Medicine
JF - Journal of Clinical Medicine
IS - 2
M1 - 675
ER -