Curriculum for endoscopic submucosal dissection training in Europe: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement

Pedro Pimentel-Nunes; Mathieu Pioche; Eduardo Albéniz; Frieder Berr; Pierre Deprez; A. Ebigbo; Pieter Dewint; Amyn Haji; Alba Panarese; Bas L. A. M. Weusten; Evelien Dekker; James E. East; David S. Sanders; Gavin Johnson; Marianna Arvanitakis; Thierry Ponchon; Mário Dinis-Ribeiro; Raf Bisschops

doi:10.1055/a-0996-0912

Endoscopy, Table of Contents

Endoscopy 2019; 51(10): 980-992
DOI: 10.1055/a-0996-0912

Position statement

Curriculum for endoscopic submucosal dissection training in Europe: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement

Pedro Pimentel-Nunes‡^*

¹Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal

²Center for research in health technologies and information systems (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal

³Surgery and Physiology Department, Faculty of Medicine of the University of Porto, Porto, Portugal

,

Mathieu Pioche‡^*

⁴Gastroenterology division, Edouard Herriot Hospital, Lyon, France

,

Eduardo Albéniz

⁵Gastroenterology Department, Endoscopy Unit, Complejo Hospitalario de Navarra, Pamplona, Spain

⁶Navarrabiomed, Universidad Pública de Navarra, IdiSNa, Pamplona, Spain

,

Frieder Berr

⁷Department of Medicine I, Paracelsus Medical University, Salzburg, Austria

,

Pierre Deprez

⁸Department of Hepato-Gastroenterology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium

,

A. Ebigbo

⁹Department of Gastroenterology, Universitätsklinikum Augsburg, Germany

,

Pieter Dewint

¹⁰Department of Gastroenterology and Hepatology, AZ Maria-Middelares, Ghent, Belgium

¹¹Department of Gastroenterology and Hepatology, UZA, Antwerp, Belgium

,

Amyn Haji

¹²King’s Institute of Therapeutic Endoscopy, King’s College Hospital, Denmark Hill, London, UK

,

Alba Panarese

¹³National Research Institute Specialized in Gastroenterology “S. de Bellis” – IRCCS, Castellana Grotte (BA), Italy

,

Bas L. A. M. Weusten

¹⁴Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht University, The Netherlands

¹⁵Department of Gastroenterology and Hepatology, St Antonius Hospital Nieuwegein, The Netherlands

,

Evelien Dekker

¹⁶Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands

,

James E. East

¹⁷Translational Gastroenterology Unit, Nuffield Department of Medicine, Experimental Medicine Division, John Radcliffe Hospital, University of Oxford, Oxford, UK

¹⁸Oxford NIHR Biomedical Research Centre, Oxford, UK

,

David S. Sanders

¹⁹Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield, UK

,

Gavin Johnson

²⁰University College London Hospitals, London, UK

,

Marianna Arvanitakis

²¹Department of Gastroenterology, Erasme University Hospital, Brussels, Belgium

,

Thierry Ponchon

⁴Gastroenterology division, Edouard Herriot Hospital, Lyon, France

,

Mário Dinis-Ribeiro

¹Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal

²Center for research in health technologies and information systems (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal

,

Raf Bisschops

²²Department of Gastroenterology and Hepatology, University Hospitals Leuven, and TARGID, KU Leuven, Belgium

› Author Affiliations

Abstract

Main Recommendation

There is a need for well-organized comprehensive strategies to achieve good training in ESD. In this context, the European Society of Gastrointestinal Endoscopy (ESGE) have developed a European core curriculum for ESD practice across Europe with the aim of high quality ESD training.

Advanced endoscopy diagnostic practice is advised before initiating ESD training. Proficiency in endoscopic mucosal resection (EMR) and adverse event management is recommended before starting ESD training

ESGE discourages the starting of initial ESD training in humans. Practice on animal and/or ex vivo models is useful to gain the basic ESD skills. ESGE recommends performing at least 20 ESD procedures in these models before human practice, with the goal of at least eight en bloc complete resections in the last 10 training cases, with no perforation. ESGE recommends observation of experts performing ESD in tertiary referral centers. Performance of ESD in humans should start on carefully selected lesions, ideally small ( < 30 mm), located in the antrum or in the rectum for the first 20 procedures. Beginning human practice in the colon is not recommended. ESGE recommends that at least the first 10 human ESD procedures should be done under the supervision of an ESD-proficient endoscopist.

Endoscopists performing ESD should be able to correctly estimate the probability of performing a curative resection based on the characteristics of the lesion and should know the benefit/risk relationship of ESD when compared with other therapeutic alternatives. Endoscopists performing ESD should know how to interpret the histopathology findings of the ESD specimen, namely the criteria for low risk resection (“curative”), local risk resection, and high risk resection (“non-curative”), as well as their implications. ESD should be performed only in a setting where early and delayed complications can be managed adequately, namely with the possibility of admitting patients to a ward, and access to appropriate emergency surgical teams for the organ being treated with ESD.

Full Text

References

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Supplementary material