Step-up training for colorectal and gastric ESD and the challenge of ESD training in the proximal colon: results from a German Center

Background and study aims The endoscopic submucosal dissection (ESD) of cancerous and precancerous lesions in the gastrointestinal (GI) tract is an effective but difficult-to-learn procedure, especially for Western endoscopists. We developed a step-up training protocol and evaluated its outcome on a single endoscopist using specific performance measures. Patients and methods The training protocol included a 12-month period of 50 observational and supervised ESD cases as well as 24 animal procedures. After completion of the protocol, ESD competency was evaluated in the first 30 independent ESD cases. Majority of lesions were located in the stomach and rectum. Performance measures included R0-resection rate, complication rate and resection speed. Results R0 resection rate was 93 %, complication rate was 7 % and median resection speed was 6,77 cm2/h. 1 case of delayed perforation with subsequent hemicolectomy occurred in the descending colon. Conclusion The ESD step-up training protocol used in this study on a single endoscopist showed excellent outcomes for lesions in the rectum and stomach. However, ESD training in the upper colon remains a challenge.