Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal.
Center for research in health technologies and information systems (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal.
Endoscopy. 2019 Oct;51(10):980-992. doi: 10.1055/a-0996-0912. Epub 2019 Aug 30.
There is a need for well-organized comprehensive strategies to achieve good training in ESD. In this context, the European Society of Gastrointestinal Endoscopy (ESGE) have developed a European core curriculum for ESD practice across Europe with the aim of high quality ESD training.Advanced endoscopy diagnostic practice is advised before initiating ESD training. Proficiency in endoscopic mucosal resection (EMR) and adverse event management is recommended before starting ESD trainingESGE discourages the starting of initial ESD training in humans. Practice on animal and/or ex vivo models is useful to gain the basic ESD skills. ESGE recommends performing at least 20 ESD procedures in these models before human practice, with the goal of at least eight en bloc complete resections in the last 10 training cases, with no perforation. ESGE recommends observation of experts performing ESD in tertiary referral centers. Performance of ESD in humans should start on carefully selected lesions, ideally small ( < 30 mm), located in the antrum or in the rectum for the first 20 procedures. Beginning human practice in the colon is not recommended. ESGE recommends that at least the first 10 human ESD procedures should be done under the supervision of an ESD-proficient endoscopist.Endoscopists performing ESD should be able to correctly estimate the probability of performing a curative resection based on the characteristics of the lesion and should know the benefit/risk relationship of ESD when compared with other therapeutic alternatives. Endoscopists performing ESD should know how to interpret the histopathology findings of the ESD specimen, namely the criteria for low risk resection ("curative"), local risk resection, and high risk resection ("non-curative"), as well as their implications. ESD should be performed only in a setting where early and delayed complications can be managed adequately, namely with the possibility of admitting patients to a ward, and access to appropriate emergency surgical teams for the organ being treated with ESD.
需要制定组织良好的综合策略来实现 ESD 的良好培训。在此背景下，欧洲胃肠道内窥镜学会（ESGE）已制定了一项针对整个欧洲 ESD 实践的欧洲核心课程，旨在实现高质量的 ESD 培训。建议在开始 ESD 培训之前进行高级内镜诊断实践。建议在开始 ESD 培训之前精通内镜黏膜切除术（EMR）和不良事件管理。ESGE 不鼓励在人体上开始初始 ESD 培训。在动物和/或离体模型上进行实践有助于获得基本的 ESD 技能。ESGE 建议在这些模型上至少进行 20 次 ESD 手术，最后 10 次培训病例中至少有 8 次整块完全切除，且无穿孔。ESGE 建议观察专家在三级转诊中心进行 ESD。在人体上进行 ESD 应从精心选择的病变开始，最初 20 例病变理想情况下为小（<30mm），位于胃窦或直肠。不建议在结肠开始人体实践。ESGE 建议至少前 10 例人体 ESD 应由 ESD 熟练的内镜医生进行监督。进行 ESD 的内镜医生应能够根据病变的特征正确估计进行根治性切除的可能性，并且应了解 ESD 与其他治疗选择相比的获益/风险关系。进行 ESD 的内镜医生应知道如何解释 ESD 标本的组织病理学发现，即低危切除（“根治性”）、局部风险切除和高危切除（“非根治性”）的标准，以及它们的含义。只有在能够充分处理早期和延迟并发症的情况下才能进行 ESD，即在有可能将患者收治到病房的情况下，并且可以获得针对接受 ESD 治疗的器官的适当紧急手术团队。
