Endoscopic Submucosal Dissection: A Country Implementation Experience and Results

Aims The adoption of endoscopic submucosal dissection (ESD) among Western countries remains slow due in part to the lack of a standardized training program. We aimed to analyze training and outcomes of ESD performed by Portuguese endoscopists with previous training in our centre and implementation at their own centres.

Methods All endoscopists trained at our centre were invited to a survey regarding 1) training period; 2) ESD outcomes and 3) implementation process. The surveyed period was the respective one since the first ESD performed. The 2011-2020 period in our own institution was considered as control (>2 endoscopists).

Results Nine endoscopists completed the survey (response rate of 100 %). The median interval to ESD implementation in each centre was one year, being the lack of mentoring (53 %) and facilities (40 %) referred as the most frequent barriers for ESD implementation and development processes. Attending hands-on courses was the most common method to complement the learning process either prior to or after the period of training with us (89 % and 78 %). During the surveyed period, a total of 1229 ESD were performed by the 9 endoscopists, mostly for gastric lesions (72.6 %). Median curative resection rate was 87 % (interquartile range 74-93.3), and median R0 resection rate was 92 % (interquartile range 81-96.8) vs curative and R0 resection rate of 81 % and 92 % respectively in our centre. Overall complication rate was 7.4 % (vs 6.5 %). Concerning future goals, endoscopists aimed to improve their technical progression according to the procedure’s complexity and to increase ESD-team size.

Conclusions Learning ESD through participation in hands-on courses and visiting high-volume centres seems to be adequate to achieve a good competence at initial stage of ESD. However, mentoring is essential for technical progression and this represents the fundamental barrier during the adoption of ESD which may be overcome with the implementation of a structured training program.

Citation: Rodriguez-Carrasco M, Libânio D, Pimentel-Nunes P et al. OP123 ENDOSCOPIC SUBMUCOSAL DISSECTION: A COUNTRY IMPLEMENTATION EXPERIENCE AND RESULTS. Endoscopy 2021; 53: S52.

Publication History

Article published online:
19 March 2021