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      ESD training: A challenging path to excellence.

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          Abstract

          Endoscopic submucosal dissection (ESD) has important advantages over endoscopic mucosal resection (EMR) for early gastrointestinal neoplasia treatment, but its difficult learning curve and associated risks have constrained its wider expansion. ESD training includes a comprehensive study of ESD basics, attending live cases and performing initial interventions in animal models, ideally under expert supervision. Mentoring methods in Japan and other Asian countries are reviewed, with a special concern in the conditions recommended for trainees to engage in an ESD program and achieve competence. Animal training is usually based on the well-known porcine model. Ex vivo models for esophageal, gastric and rectal ESD are cheap and easy to set up, whereas in vivo training requires special settings and veterinarian support. Nevertheless, it is advisable to gain experience in the live pig, with conditions that are similar to humans, before moving on to real patients. Particular attention is focused on colorectal ESD (CR-ESD), one of the most difficult locations for this technique. Since most of the potential lesions for ESD in Western countries are located in the colon or rectum, excellence in training is of paramount importance for successful outcomes in CR-ESD in the West.

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          Author and article information

          Journal
          World J Gastrointest Endosc
          World journal of gastrointestinal endoscopy
          Baishideng Publishing Group Inc.
          1948-5190
          Apr 16 2014
          : 6
          : 4
          Affiliations
          [1 ] Alberto Herreros de Tejada, Department of Gastroenterology, IDIPHIM, Puerta de Hierro University Hospital, 28222 Madrid, Spain.
          Article
          10.4253/wjge.v6.i4.112
          3985151
          24748918

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