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Endoscopic Submucosal Dissection Training in Western Countries

  • Adolfo Parra-Blanco
  • Vitor Arantes
  • Nicolás González
  • Alberto Herreros de Tejada
  • Andrés Donoso

Abstract

This chapter has been included because there are major differences between Japan, and to a lesser extent South Korea, and western countries in the application of endoscopic submucosal dissection (ESD). Among the differences is the fact that for decades special consideration has been given in Japan to early flat neoplastic lesions in the digestive tract, which forms an important part of their macroscopic classifications. As well, endoscopic mucosal resection (EMR), only now considered standard in western countries, has been applied in Japan for many years (especially before the advent of ESD). Staining and digital chromoendoscopy, and magnification endoscopy for the detailed diagnosis of early neoplasms, are part of the basic knowledge of endoscopists in Japan, while in western countries even traditional chromoendoscopy has not yet been fully adopted. For example, while ESD was being developed in Japan, the importance of flat colorectal lesions was still debated in western countries and EMR was still not routinely performed in many endoscopy units. In effect, Japan and to a lesser extent South Korea are much more advanced than western countries in ESD and should be a reference in training endoscopists in this complex, exciting, and useful technique.

Keywords

Endoscopic submucosal dissection Training Western countries Animal models 

References

  1. 1.
    Neuhaus H, Costamagna G, Devière J, Fockens P, Ponchon T, Rösch T. Endoscopic submucosal dissection (ESD) of early neoplastic gastric lesions using a new double-channel endoscope (the “R-scope”). Endoscopy. 2006;38:1016–23.PubMedCrossRefGoogle Scholar
  2. 2.
    Probst A, Golger D, Arnholdt H, Messmann H. Endoscopic submucosal dissection of early cancers, flat adenomas, and submucosal tumors in the gastrointestinal tract. Clin Gastroenterol Hepatol. 2009;7:149–55.PubMedCrossRefGoogle Scholar
  3. 3.
    Dinis-Ribeiro M, Pimentel-Nunes P, Afonso M, Costa N, Lopes C, Moreira-Dias L. A European case series of endoscopic submucosal dissection for gastric superficial lesions. Gastrointest Endosc. 2009;69:350–5.PubMedCrossRefGoogle Scholar
  4. 4.
    Repici A, Hassan C, Carlino A, et al. Endoscopic submucosal dissection in patients with early esophageal squamous cell carcinoma: results from a prospective Western series. Gastrointest Endosc. 2010;71:715–21.PubMedCrossRefGoogle Scholar
  5. 5.
    Coda S, Trentino P, Antonellis F, et al. A Western single-center experience with endoscopic submucosal dissection for early gastrointestinal cancers. Gastric Cancer. 2010;13:258–63.PubMedCrossRefGoogle Scholar
  6. 6.
    Farhat S, Chaussade S, Ponchon T, et al. Endoscopic submucosal dissection in a European setting. A multi-institutional report of a technique in development. Endoscopy. 2011;43:664–70.PubMedCrossRefGoogle Scholar
  7. 7.
    Iacopini F, Bella A, Costamagna G, et al. Stepwise training in rectal and colonic endoscopic submucosal dissection with differentiated learning curves. Gastrointest Endosc. 2012;76:1188–96.PubMedCrossRefGoogle Scholar
  8. 8.
    Chaves DM, Moura EG, Milhomem D. Initial experience of endoscopic submucosal dissection in Brazil to treat early gastric and esophagheal cancer: a multi-institutional analysis. Arq Gastroenterol. 2013;50:148–52.PubMedCrossRefGoogle Scholar
  9. 9.
    Deprez PH, Bergman JJ, Meisner S, et al. Current practice with endoscopic submucosal dissection in Europe: position statement from a panel of experts. Endoscopy. 2010;42:853–8.PubMedCrossRefGoogle Scholar
  10. 10.
    Ribeiro-Mourão F, Pimentel-Nunes P, Dinis-Ribeiro M. Endoscopic submucosal dissection for gastric lesions: results of an European inquiry. Endoscopy. 2010;42:814–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Arantes V, Albuquerque W, Freitas Dias CA, Demas Alvares Cabral MM, Yamamoto H. Standardized endoscopic submucosal tunnel dissection for management of early esophageal tumors (with video). Gastrointest Endosc. 2013;78:946–52.PubMedCrossRefGoogle Scholar
  12. 12.
    Yokoyama A, Ohmori T, Makuuchi H, et al. Successful screening for early esophageal cancer in alcoholics using endoscopy and mucosa iodine staining. Cancer. 1995;76:928–34.PubMedCrossRefGoogle Scholar
  13. 13.
    Muto M, Hironaka S, Nakane M, Boku N, Ohtsu A, Yoshida S. Association of multiple Lugol-voiding lesions with synchronous and metachronous esophageal squamous cell carcinoma in patients with head and neck cancer. Gastrointest Endosc. 2002;56:517–21.PubMedCrossRefGoogle Scholar
  14. 14.
    Takahashi H, Arimura Y, Masao H. Endoscopic submucosal dissection is superior to conventional endoscopic resection as a curative treatment for early squamous cell carcinoma of the esophagus (with video). Gastrointest Endosc. 2010;72:255–64.PubMedCrossRefGoogle Scholar
  15. 15.
    Bergman JJ, Zhang YM, He S, Weusten B, et al. Outcomes from a prospective trial of endoscopic radiofrequency ablation of early squamous cell neoplasia of the esophagus. Gastrointest Endosc. 2011;74:1181–90.PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Bennett C, Vakil N, Bergman J, et al. Consensus statements for management of Barrett’s dysplasia and early-stage esophageal adenocarcinoma, based on a Delphi process. Gastroenterology. 2012;143:336–46.PubMedCrossRefGoogle Scholar
  17. 17.
    Ell C, May A, Gossner L, et al. Endoscopic mucosal resection of early cancer and high-grade dysplasia in Barrett’s esophagus. Gastroenterology. 2000;118:670–7.PubMedCrossRefGoogle Scholar
  18. 18.
    Neuhaus H, Terheggen G, Rutz EM, Vieth M, Schumacher B. Endoscopic submucosal dissection plus radiofrequency ablation of neoplastic Barrett’s esophagus. Endoscopy. 2012;44:1105–13.PubMedCrossRefGoogle Scholar
  19. 19.
    Deprez PH, Piessevaux H, Aouattah T, Yeung RC, Sempoux C, Jouret-Mourin A. ESD in Barrett’s esophagus high grade dysplasia and mucosal cancer: prospective comparison with CAP mucosectomy. Gastrointest Endosc. 2010;71:126.Google Scholar
  20. 20.
    Bergman JJ. How to justify endoscopic submucosal dissection in the Western world. Endoscopy. 2009;41:988–90.PubMedCrossRefGoogle Scholar
  21. 21.
    Kojima T, Parra-Blanco A, Takahashi H, Fujita R. Outcome of endoscopic mucosal resection for early gastric cancer: review of the Japanese literature. Gastrointest Endosc. 1998;48:550–4.PubMedCrossRefGoogle Scholar
  22. 22.
    Yamamoto Y, Fujisaki J, Ishiyama A, Hirasawa T, Igarashi M. Current status of training for endoscopic submucosal dissection for gastric epithelial neoplasm at Cancer Institute Hospital, Japanese Foundation for Cancer Research, a famous Japanese hospital. Dig Endosc. 2012;24 Suppl 1:148–53.PubMedCrossRefGoogle Scholar
  23. 23.
    Oda I, Odagaki T, Suzuki H, Nonaka S, Yoshinaga S. Learning curve for endoscopic submucosal dissection of early gastric cancer based on trainee experience. Dig Endosc. 2012;24 Suppl 1:129–32.PubMedCrossRefGoogle Scholar
  24. 24.
    Gotoda T, Yanagisawa A, Sasako M, et al. Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer. 2000;3:219–25.PubMedCrossRefGoogle Scholar
  25. 25.
    Hopper AD, Bourke MJ, Hourigan LF, Tran K, Moss A, Swan MP. En bloc resection of multiple type 1 gastric carcinoid tumors by endoscopic multi-band mucosectomy. J Gastroenterol Hepatol. 2009;24:1516–21.PubMedCrossRefGoogle Scholar
  26. 26.
    Sato Y, Takeuchi M, Hashimoto S, et al. Usefulness of endoscopic submucosal dissection for type I gastric carcinoid tumors compared with endoscopic mucosal resection. Hepatogastroenterology. 2013;60:1524–9.PubMedGoogle Scholar
  27. 27.
    Swan MP, Bourke MJ, Alexander S, Moss A, Williams SJ. Large refractory colonic polyps: is it time to change our practice? A prospective study of the clinical and economic impact of a tertiary referral colonic mucosal resection and polypectomy service (with videos). Gastrointest Endosc. 2009;70:1128–36.PubMedCrossRefGoogle Scholar
  28. 28.
    Matsuda T, Gotoda T, Saito Y, Nakajima T, Conio M. Our perspective on endoscopic resection for colorectal neoplasms. Gastroenterol Clin Biol. 2010;34:367–70.PubMedCrossRefGoogle Scholar
  29. 29.
    Bianco MA, Cipolletta L, Rotondano G, Buffoli F, Gizzi G, Tessari F, Flat Lesions Italian Network (FLIN). Prevalence of nonpolypoid colorectal neoplasia: an Italian multicenter observational study. Endoscopy. 2010;42:279–85.PubMedCrossRefGoogle Scholar
  30. 30.
    Uraoka T, Parra-Blanco A, Yahagi N. Colorectal endoscopic submucosal dissection: is it suitable in western countries? J Gastroenterol Hepatol. 2013;28:406–14.PubMedCrossRefGoogle Scholar
  31. 31.
    Saito Y, Uraoka T, Yamaguchi Y, et al. A prospective, multicenter study of 1111 colorectal endoscopic submucosal dissections (with video). Gastrointest Endosc. 2010;72:1217–25.PubMedCrossRefGoogle Scholar
  32. 32.
    Choi IJ, Kim CG, Chang HJ, Kim SG, Kook MC, Bae JM. The learning curve for EMR with circumferential mucosal incision in treating intramucosal gastric neoplasm. Gastrointest Endosc. 2005;62:860–5.PubMedCrossRefGoogle Scholar
  33. 33.
    Kakushima N, Fujishiro M, Kodashima S, Muraki Y, Tateishi A, Omata M. A learning curve for endoscopic submucosal dissection of gastric epithelial neoplasms. Endoscopy. 2006;38:991–5.PubMedCrossRefGoogle Scholar
  34. 34.
    Yamamoto S, Uedo N, Ishihara R, et al. Endoscopic submucosal dissection for early gastric cancer performed by supervised residents: assessment of feasibility and learning curve. Endoscopy. 2009;41:923–8.PubMedCrossRefGoogle Scholar
  35. 35.
    Draganov PV, Gotoda T, Chavalitdhamrong D, Wallace MB. Techniques of endoscopic submucosal dissection: application for the Western endoscopist? Gastrointest Endosc. 2013;78:677–88.PubMedCrossRefGoogle Scholar
  36. 36.
    Sakamoto T, Saito Y, Fukunaga S, Nakajima T, Matsuda T. Learning curve associated with colorectal endoscopic submucosal dissection for endoscopists experienced in gastric endoscopic submucosal dissection. Dis Colon Rectum. 2011;54:1307–12.PubMedCrossRefGoogle Scholar
  37. 37.
    Gotoda T, Friedland S, Hamanaka H, Soetikno R. A learning curve for advanced endoscopic resection. Gastrointest Endosc. 2005;62:866–7.PubMedCrossRefGoogle Scholar
  38. 38.
    Vázquez-Sequeiros E, de Miquel DB, Olcina JR, et al. Training model for teaching endoscopic submucosal dissection of gastric tumors. Rev Esp Enferm Dig. 2009;101:546–52.PubMedGoogle Scholar
  39. 39.
    Tanimoto MA, Torres-Villalobos G, Fujita R, et al. Endoscopic submucosal dissection in dogs in a World Gastroenterology Organization training center. World J Gastroenterol. 2010;16:1759–64.PubMedCentralPubMedCrossRefGoogle Scholar
  40. 40.
    Parra-Blanco A, Arnau MR, Nicolás-Pérez D, et al. Endoscopic submucosal dissection training with pig models in a Western country. World J Gastroenterol. 2010;16:2895–900.PubMedCentralPubMedCrossRefGoogle Scholar
  41. 41.
    González N, Parra-Blanco A, Villa-Gómez M, et al. Gastric endoscopic submucosal dissection: from animal model to patient. World J Gastroenterol. 2013;19:8326–34.PubMedCentralPubMedCrossRefGoogle Scholar
  42. 42.
    Kato M, Gromski M, Jung Y, Chuttani R, Matthes K. The learning curve for endoscopic submucosal dissection in an established experimental setting. Surg Endosc. 2013;27:154–61.PubMedCrossRefGoogle Scholar
  43. 43.
    Hirasawa K, Kokawa A, Kou R, Oka H, Maeda S, Tanaka K. Determining early gastric cancer lesions appropriate for endoscopic submucosal dissection trainees: a proposal related to curability. Dig Endosc. 2012;24 Suppl 1:143–7.PubMedCrossRefGoogle Scholar
  44. 44.
    Hotta K, Oyama T, Shinohara T. Learning curve for endoscopic submucosal dissection of large colorectal tumors. Dig Endosc. 2010;22:302–6.PubMedCrossRefGoogle Scholar
  45. 45.
    Repici A, Conio M, De Angelis C. Insulated-tip knife endoscopic mucosal resection of large colorectal polyps unsuitable for standard polypectomy. Am J Gastroenterol. 2007;102:1617–23.PubMedCrossRefGoogle Scholar
  46. 46.
    Tanimoto MA, Torres-Villalobos G, Fujita R, et al. Learning curve in a Western training center of the circumferential en bloc esophageal endoscopic submucosal dissection in an in vivo animal model. Diagn Ther Endosc. 2011;2011:847831.PubMedCentralPubMedCrossRefGoogle Scholar
  47. 47.
    Tanaka S, Morita Y, Fujita T, et al. Ex vivo pig training model for esophageal endoscopic submucosal dissection (ESD) for endoscopists with experience in gastric ESD. Surg Endosc. 2012;26:1579–86.PubMedCrossRefGoogle Scholar
  48. 48.
    Hon SS, Ng SS, Lee JF, Li JC, Lo AW. In vitro porcine training model for colonic endoscopic submucosal dissection: an inexpensive and safe way to acquire a complex endoscopic technique. Surg Endosc. 2010;24:2439–43.PubMedCrossRefGoogle Scholar
  49. 49.
    Yoshida N, Yagi N, Inada Y, et al. Possibility of ex vivo animal training model for colorectal endoscopic submucosal dissection. Int J Colorectal Dis. 2013;28:49–56.PubMedCrossRefGoogle Scholar
  50. 50.
    Kaltenbach T, Muto M, Soetikno R, et al. Teleteaching endoscopy: the feasibility of real-time, uncompressed video transmission by using advanced-network technologies. Gastrointest Endosc. 2009;70:1013–7.PubMedCrossRefGoogle Scholar
  51. 51.
    Gotoda T, Kusano C, Nonaka M, et al. Non-anesthesiologist administrated propofol (NAAP) during endoscopic submucosal dissection for elderly patients with early gastric cancer. Gastric Cancer. 2014;17:686–691.Google Scholar
  52. 52.
    Chun SY, Kim KO, Park DS, et al. Safety and efficacy of deep sedation with propofol alone or combined with midazolam administrated by nonanesthesiologist for gastric endoscopic submucosal dissection. Gut Liver. 2012;6:464–70.PubMedCentralPubMedCrossRefGoogle Scholar
  53. 53.
    Park CH, Min JH, Yoo YC, et al. Sedation methods can determine performance of endoscopic submucosal dissection in patients with gastric neoplasia. Surg Endosc. 2013;27:2760–7.PubMedCrossRefGoogle Scholar
  54. 54.
    Probst A, Pommer B, Golger D, et al. Endoscopic submucosal dissection in gastric neoplasia—experience from a European center. Endoscopy. 2010;42:1037–44.PubMedCrossRefGoogle Scholar
  55. 55.
    Toyokawa T, Inaba T, Omote S, et al. Risk factors for perforation and delayed bleeding associated with endoscopic submucosal dissection for early gastric neoplasms: analysis of 1123 lesions. J Gastroenterol Hepatol. 2012;27:907–12.PubMedCrossRefGoogle Scholar
  56. 56.
    Teoh AY, Chiu PW, Wong SK, et al. Difficulties and outcomes in starting endoscopic submucosal dissection. Surg Endosc. 2010;24:1049–54.PubMedCrossRefGoogle Scholar
  57. 57.
    Takizawa K, Oda I, Gotoda T, et al. Routine coagulation of visible vessels may prevent delayed bleeding after endoscopic submucosal dissection—an analysis of risk factors. Endoscopy. 2008;40:179–83.PubMedCrossRefGoogle Scholar
  58. 58.
    Toyonaga T, Nishino E, Man IM, et al. Principles of quality controlled endoscopic submucosal dissection with appropriate dissection level and high quality resected specimen. Clin Endosc. 2012;45:362–74.PubMedCentralPubMedCrossRefGoogle Scholar
  59. 59.
    Toyonaga T, Man-I M, Morita Y, et al. The new resources of treatment for early stage colorectal tumors: EMR with small incision and simplified endoscopic submucosal dissection. Dig Endosc. 2009;21 Suppl 1:S31–7.PubMedCrossRefGoogle Scholar
  60. 60.
    Moss A, Bourke MJ, Metz AJ, et al. Beyond the snare: technically accessible large en bloc colonic resection in the West: an animal study. Dig Endosc. 2012;24:21–9.PubMedCrossRefGoogle Scholar
  61. 61.
    Sakamoto T, Matsuda T, Nakajima T, Saito Y. Efficacy of endoscopic mucosal resection with circumferential incision for patients with large colorectal tumors. Clin Gastroenterol Hepatol. 2012;10:22–6.PubMedCrossRefGoogle Scholar
  62. 62.
    Sakurazawa N, Kato S, Fujita I, Kanazawa Y, Onodera H, Uchida E. Supportive techniques and devices for endoscopic submucosal dissection of gastric cancer. World J Gastrointest Endosc. 2012;4:231–5.PubMedCentralPubMedCrossRefGoogle Scholar
  63. 63.
    Fukami N. What we want for ESD is a second hand! Traction method. Gastrointest Endosc. 2013;78:274–6.PubMedCrossRefGoogle Scholar
  64. 64.
    Sakamoto N, Osada T, Shibuya T, et al. The facilitation of a new traction device (S-O clip) assisting endoscopic submucosal dissection for superficial colorectal neoplasms. Endoscopy. 2008;40 Suppl 2:E94–5.PubMedCrossRefGoogle Scholar
  65. 65.
    Parra-Blanco A, Nicolas D, Arnau MR, Gimeno-Garcia AZ, Rodrigo L, Quintero E. Gastric endoscopic submucosal dissection assisted by a new traction method: the clip-band technique. A feasibility study in a porcine model (with video). Gastrointest Endosc. 2011;74:1137–41.PubMedCrossRefGoogle Scholar
  66. 66.
    Parra-Blanco A, Uraoka T, Ortiz Fernández-Sordo J, et al. Is a traction method (Clip-Band) useful to facilitate gastric endoscopic submucosal dissection? A prospective, randomized controlled trial in a live Porcine Model. Gastrointest Endosc. 2013;77:AB123.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Adolfo Parra-Blanco
    • 1
  • Vitor Arantes
    • 2
  • Nicolás González
    • 3
  • Alberto Herreros de Tejada
    • 4
  • Andrés Donoso
    • 5
  1. 1.Department of Gastroenterology, School of MedicinePontificia Universidad Católica de ChileSantiagoChile
  2. 2.Alfa Institute, School of MedicineMinas Gerais Federal UniversityBelo HorizonteBrazil
  3. 3.Department of GastroenterologyHospital de ClínicasMontevideoUruguay
  4. 4.Department of GastroenterologyIDIPHIM. Puerta de Hierro University Hospital, Universidad Autónoma de MadridMadridSpain
  5. 5.Department of Surgery, School of MedicinePontificia Universidad Católica de ChileSantiagoChile

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