Aims
Aims & Background: Endoscopic submucosal dissection (ESD) is state-of-the-art en-bloc resection for early gastro-intestinal cancers and precursors developed and validated in Japan. Western expertise with this complex technique remains limited. Tutored training might be optimal for patients and ESD learning1. Aims: We established ESD tutoring courses led by experienced Japanese experts to provide (i) optimal long-term curative outcomes and low complication rates for patients, and (ii) hands-on training on difficult lesions for European endoscopists under direct expert supervision.
Methods
Prospective data from 2011–2015 (follow-up to 12/2024) were analyzed. A total of 118 neoplasms (50% HGIEN & cancer) in 101 patients (median age 68 [37–91] years; 38% with significant comorbidities) were treated with expert or tutored ESD. The neoplasms (n) were located in esophagus & cardia (22), stomach (14), duodenum (9), and colorectum (72). Japanese experts performed 28 ESDs, while 22 trained beginners conducted 90 supervised procedures on difficult lesions during 5 live and 20 tutoring events (1–4 days each, total 54 d).
Results
Analysis of the complete data showed en bloc and curative resection rates of 95% and 88%, with no recurrence after R0 resections during a median follow-up of 9.8 [1.5–14.9] years. Long-term survival remained recurrence-free after endoscopic resection of 3 recurrent adenomas (at R1/Rx) and curative surgery /2nd ESD for 5 non-curative ESD. Adverse events occurred in 9.3% without emergency surgery or 30-day mortality. Comparing expert only vs. tutored ESD procedures, beginners correctly applied curative ESD indications in 94% of ESD. Experts resected larger lesions (22 cm²) at 9.3 cm²/h in 121 minutes. Tutored beginners achieved a 75% [25–100] self-completion rate on 33% smaller lesions in 112 min.
Conclusions
ESD tutoring courses led by Japanese top experts ensure curative patient outcomes and standardized training on complex lesions during routine endoscopy program. This model may advance current ESD performance across European referral centers.