Z Gastroenterol 2025; 63(08): e614-e615
DOI: 10.1055/s-0045-1811095
Abstracts | DGVS/DGAV
Kurzvorträge
KI-Systeme, Datenmanagement & Workflow-Optimierung in der Endoskopie Freitag, 19. September 2025, 17:25 – 18:29, Seminarraum 6 + 7

Endoscopic submucosal dissection (ESD) by trainees tutored by experts: long-term results of ESGE-endorsed courses and live endoscopic events 2011-2015

Authors

  • D Neureiter

    1   Inst. f. Pathologie, Salzburg, Österreich

  • N Yahagi

    2   Keio Univ. School of Medicine, Div. of Research & Development of Min. Invas. Tretment., Tokyo, Japan

  • T Oyama

    3   Saku Central Hospital Advanced Care Ctr, Dept. of Endoscopy, Saku, Japan

  • T Kiesslich

    4   Paracelsus Med. Univ. Hospital, Dept. of Medicine I & Inst. of Physiology, Salzburg, Österreich

  • A Wagner

    5   Klinikum SO-Bayern, Bad Reichenhall, Dept Medicine-Gastroenteology, Bad Reichenhall, Deutschland

  • T Toyonaga

    6   Kobe Univ. Hospital, Dept. of Endoscopy, Kobe, Japan

  • T Uraoka

    7   Gunma Univ. Hospital, Dept. of Gastroenterology & Hepatology, Maebashi, Japan

  • A Takahashi

    3   Saku Central Hospital Advanced Care Ctr, Dept. of Endoscopy, Saku, Japan

  • A Ziachehabi

    8   Ordensklinikum Linz GmbH, Dept. Medicine IV, Linz, Österreich

  • H-P Allgaier

    9   Evang. Diakoniekrankenhaus, Viszeralmedizinische Zentrum, Freiburg, Deutschland

  • F-L Dumoulin

    10   Gemeinschaftskrankenhaus Bonn, Dept. Internal Medicine, Bonn, Deutschland

  • G Kleber

    11   Ostalb-Klinikum Aalen, Med. Klinik I, Aalen, Deutschland

  • M Anzinger

    12   Barmherzige Brüder Krankenhaus, Innere Medizin I – Gastroenterologie, Muenchen, Deutschland

  • M Lutz

    13   Caritas Klinikum Saarbrücken, Dept. of Gastroenterology, Saarbruecken, Deutschland

  • H Seifert

    14   Klinikum Oldenburg, Dept. Gastroenterology, Oldenburg, Deutschland

  • K Heiler

    15   Klinikum SO-Bayern Traunstein, Dept. ofGastroenterology, Traunstein, Deutschland

  • A Herreros de Tejada

    16   Univ. Hosp. Puerta de Hierro, Dept of Gastroenterology, Madrid, Spanien

  • I Steinbrueck

    17   Asklepios Klinikum Barmbeck, Dept. of Gastroenterology, Hamburg, Deutschland

  • B Tribl

    18   AKH, Med. Univ. Wien, Medicine – Dept. Gastroenterology, Wien, Österreich

  • A Tringali

    19   Ospedale Conegliano, Dept. Medicine-Gastroenterology, Conegliano, Italien

  • C Österreicher

    20   Hanusch Krankenhaus, Medizin – Gastroenterologie, Wien, Österreich

  • A Ebigbo

    21   Univ. Hospital Bochum, Dept. Medicine – Gastroenterology, Bochum, Deutschland

  • J Hochberger

    22   Charité – Universitätsmedizin Berlin, Med. Clinic – Gastroenterology & Hepatology, Berlin, Deutschland

  • S V Kantsevoy

    23   Univ. Maryland School of Medicine, Mercy Med Ctr – Instit. Digestive & Liver Diseases, Baltimore, PA, Vereinigte Staaten

  • F Berr

    24   Paracelsus Med. Univ. Hospital, Prof. em. of Dept. Medicine I, Salzburg, Österreich
Further Information
Also available at
 
 

    Introduction: Endoscopic diagnostic and electrosurgical skills for accurate indication and curative en bloc resection with ESD of early malignant lesion have been developed and validated in Japan.

    Aim: To enhance curative resection rate and learning curve for implementation of ESD on site.

    Methods: Patients (n=106; 68 [37 – 91] years old, 38% comorbidity≥grade III) with neoplasias (n=123; 22 esophageal, 14 gastric, 13 duodenal, 74 colorectal) fulfilling Japanese criteria for en-bloc resection were referred with consent for tutored ESD to Salzburg from Sept 2011 – June 2015. European endoscopists with initial clinical ESD experience and one of the four Japanese experts resected the lesions – under legal responsibility of the organizer*– in 20 tutoring sessions (each lasting 1 – 4 days, 22 active and 39 passive participants from 17 countries) and 5 Live Endoscopic Events (each 1 day, 2 more experts).

    Results: Tutors a priori performed piecemeal-EMR in 4 patients. ESD intention (ESD-ITT, 119 lesions; 59 benign, 60 malignant) was diagnostic (5%) for 6 carcinomas cN0 (2 esophageal, 3 Barrett´s, 1 rectum LST-GN) and curative for 113 lesions. Accuracy of visual grading for ESD indication was 87%. ESD was en bloc (95%) for 113 neoplasias including all malignancies (R0 93%; R curative 88%), and 4 of 6 diagnostic ESD underwent curative oncosurgery. Self-completion rate of 90 trainee ESD-ITT was 75 [25-100]%. Recurrence rate was zero after resection R0, and 4% after resection R1/Rx, i.e. 1 coloncarcinoma pT1b sm1 cured with 2nd ESD, and 4 LGIEN snared without recurrence. Adverse events (11 AE) occurred in 9.2% of ESD-ITT, all managed without mortality or surgery or long-term morbidity; 5 colorectal microperforations (4%) were inconsequential. Long-term follow-up is 98% for the living (n=60; 11±1.6 yrs, RFS 9±2.8 yrs; age 74±10 yrs), and 100% (endoscopic 93%) for the deceased (n=42; 5.7±3.2 yrs, RFS 4.4±3 yrs, died at age 80±10 yrs). Recurrent progressive disease did not occur in any patient after non-curative ESD.

    Conclusion: Performance of ESD under tutoring of experts leads to the best curative outcomes even for challenging lesions in comorbid elderly patients, and optimally enhances the diagnostic and electrosurgical skills of ESD trainees.


     

    Publication History

    Article published online:
    04 September 2025

    © 2025. Thieme. All rights reserved.

    Georg Thieme Verlag KG
    Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany