Adoption of ESD has been limited and gradual in western centres due to the complexity of the procedure, a long learning curve, limited opportunities to train and a lack of standard guidelines for training. Most ESD practitioners embark on training “in-post” after specialisation and ESD fellowships are scarce. There are no reports from western centres of high volume ESD training of endoscopy fellows. The ESGE have published a recommended curriculum for ESD training, including a recommendation for 10 ESDs to be completed under mentorship before independent practice. We report the experience of ESD training in a structured fellowship toward achieving this standard.

Patients who underwent colorectal ESD at a tertiary referral centre were included. Data recorded included procedure time, en bloc and R0 resection, complications and proficiency of resection in cm²/hr. Outcomes of ESD performed by fellows were reported and time to achieve 10 independent resections under mentorship was calculated for those following a dedicated ESD training program

1077 lesions were treated using ESD. Fellows performed part or complete ESD of 277 lesions at an average of 23 cases per fellow (range 3-105). 80% of fellow performed ESD were rectal lesions versus 57% of expert performed ESD. En bloc and R0 resection rates for ESD involving fellows were 99% and 85%. There was no difference in complications (p=0.75) between trainers and fellows. Mean proficiency of ESD involving fellows was 8.3cm²/hr, 5 of 12 fellows who performed ESD followed a dedicated ESD training program, all achieving 10 independently performed ESDs. 2 had interrupted training periods due to research and other commitments. For the rest, the time from first ESD experience in patients of any kind to completing the 10^th independent ESD was 46, 52, and 33 weeks

Conclusion

In one of the first reports of fellow training in significant volume of ESD in western centres, we demonstrate that structured training consistently results in achieving ESGE ESD training curriculum requirements within an acceptable fellowship period. Training can be achieved with high quality outcomes and acceptable proficiency without compromising patient safety.