Endoscopy 2019; 51(10): 980-992
DOI: 10.1055/a-0996-0912
Position statement
© Georg Thieme Verlag KG Stuttgart · New York

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

Pedro Pimentel-Nunes*
 1  Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal
 2  Center for research in health technologies and information systems (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
 3  Surgery and Physiology Department, Faculty of Medicine of the University of Porto, Porto, Portugal
,
Mathieu Pioche*
 4  Gastroenterology division, Edouard Herriot Hospital, Lyon, France
,
Eduardo Albéniz
 5  Gastroenterology Department, Endoscopy Unit, Complejo Hospitalario de Navarra, Pamplona, Spain
 6  Navarrabiomed, Universidad Pública de Navarra, IdiSNa, Pamplona, Spain
,
Frieder Berr
 7  Department of Medicine I, Paracelsus Medical University, Salzburg, Austria
,
Pierre Deprez
 8  Department of Hepato-Gastroenterology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
,
A. Ebigbo
 9  Department of Gastroenterology, Universitätsklinikum Augsburg, Germany
,
Pieter Dewint
10  Department of Gastroenterology and Hepatology, AZ Maria-Middelares, Ghent, Belgium
11  Department of Gastroenterology and Hepatology, UZA, Antwerp, Belgium
,
Amyn Haji
12  King’s Institute of Therapeutic Endoscopy, King’s College Hospital, Denmark Hill, London, UK
,
Alba Panarese
13  National Research Institute Specialized in Gastroenterology “S. de Bellis” – IRCCS, Castellana Grotte (BA), Italy
,
Bas L. A. M. Weusten
14  Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht University, The Netherlands
15  Department of Gastroenterology and Hepatology, St Antonius Hospital Nieuwegein, The Netherlands
,
Evelien Dekker
16  Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
,
James E. East
17  Translational Gastroenterology Unit, Nuffield Department of Medicine, Experimental Medicine Division, John Radcliffe Hospital, University of Oxford, Oxford, UK
18  Oxford NIHR Biomedical Research Centre, Oxford, UK
,
David S. Sanders
19  Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield, UK
,
Gavin Johnson
20  University College London Hospitals, London, UK
,
Marianna Arvanitakis
21  Department of Gastroenterology, Erasme University Hospital, Brussels, Belgium
,
Thierry Ponchon
 4  Gastroenterology division, Edouard Herriot Hospital, Lyon, France
,
Mário Dinis-Ribeiro
 1  Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal
 2  Center for research in health technologies and information systems (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
,
Raf Bisschops
22  Department of Gastroenterology and Hepatology, University Hospitals Leuven, and TARGID, KU Leuven, Belgium
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Publikationsverlauf

Publikationsdatum:
30. August 2019 (online)

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.

* Equal first authors


Appendix 1s