Endoscopic submucosal dissection skills transfer to clinical practice after hands-on workshops: An international survey

Ricardo Küttner Magalhães, Mário Dinis-Ribeiro, Ricardo Marcos-Pinto, Carla Rolanda, Arjun D. Koch*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

2 Citations (Scopus)
15 Downloads (Pure)


Background: Endoscopic submucosal dissection (ESD) is a complex procedure, requiring enhanced technical skills. Translation into clinical practice of ESD training programs has not been documented. Our aim was to assess ESD training pathways of endoscopists participating in dedicated workshops and its clinical impact on ESD outcomes. Methods: Participants of live porcine models ESD workshops, from 2013 to 2019, were included. They were invited to complete a survey focusing on human ESD performance after training, prior skills/competencies, complete learning pathway, and clinical outcomes. Results: From 118 invited participants, 40 (34%) completed the questionnaire. Nineteen (47%) endoscopists performed human ESD after the workshop, predominantly male (89%). At the beginning of human ESD, endoscopists had a mean of 7.7 (standard deviation (SD) 4.1) years of endoscopic experience and were all performing endoscopic mucosal resection (and emergency endoscopy. Before ESD practice, 100% of the participants were trained with live animal models and 68% with ex vivo models. The majority started clinical ESD in the lower third of the stomach or rectum (90%), with lesions ≤30 mm (89%). Each endoscopist performed a median of 19 (interquartile range 8-32) cumulative ESDs, over a mean of 3.9 (SD 2.0) years. Total en bloc resection rate was 92%, R0 resection rate 88%, and curative resection rate 86%, whereas adverse events remained <10%. Endoscopists with >10 human ESD procedures achieve clinical competence thresholds. Conclusions: Participants of ESD workshops are adequately skilled prior to clinical ESD, complying with recommendations for training and properly implementing the technique. Transfer to clinical practice, of prior ESD skills obtained in hands-on training courses, was documented. Structured training programs achieve clinical outcomes exceeding established standards, namely in the very initial clinical phase.

Original languageEnglish
Pages (from-to)665–674
Number of pages10
JournalDigestive Diseases
Issue number5
Publication statusPublished - 2021

Bibliographical note

Funding Information:
This research did not receive any specific grant from funding agencies in the public, commercial or nonprofit sectors. The workshops were unrestrictedly sponsored by Pentax (Tokyo, Japan), ERBE (Tubingen, Germany), Karl Storz (Tuttlingen, Germany) and, Cook Medical (Winston-Salem, NC, USA), which provided flexible endoscopes, electrosurgical units, and endoscopic devices

Publisher Copyright:
© 2021 The Author(s). Published by S. Karger AG, Basel.


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