Department of Gastroenterology and Hepatology, McGill University Health Center, Montreal, QC, Canada.
Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, USA.
Curr Gastroenterol Rep. 2025 Dec;27(1):7. doi: 10.1007/s11894-024-00951-7. Epub 2024 Nov 30.
Esophageal cancer is one of the most common cancers in the world and carries a poor prognosis. While esophagectomy poses considerable mortality and morbidity risks, endoscopic resection can provide a safer and less invasive alternative. RECENT FINDINGS: Endoscopic resection therapy has allowed a less invasive approach with comparable outcomes to esophagectomy. EMR is considered safe and requires less intensive training, yet it does not offer complete histopathological assessment due to the nature of piecemeal resection for larger lesions. Alternatively, ESD offers an R0 resection, therefore allowing precise histopathological evaluation. Training in ESD is essential; however, a uniform training model has not been agreed upon. The Japanese apprenticeship training model has proven effective, with promising training outcomes from the Eastern experience. In the West, a comprehensive training model through a combination of apprenticeship with progressive exposure, including ex-vivo and live animal hands-on training, could be the optimal approach. Different methods of ESD training are currently available, all of which aim to provide the experience needed to perform safe ESD. Despite the differences in training styles between the East and the West, a modified apprenticeship model could potentially result in more effective and better training outcomes. The currently available technologies provide the environment to enhance ESD training.
食管癌是世界上最常见的癌症之一，预后不良。虽然食管切除术有相当大的死亡率和发病率风险，但内镜下切除可以提供一种更安全、侵入性更小的选择。 最新发现：内镜下切除治疗可以采用一种更微创的方法，其结果与食管切除术相当。EMR 被认为是安全的，需要的培训也不那么密集，但由于较大病变的分片切除性质，它不能提供完整的组织病理学评估。相比之下，ESD 可以进行 R0 切除，因此可以进行精确的组织病理学评估。ESD 培训是必不可少的，但尚未达成统一的培训模式。日本的学徒培训模式已被证明是有效的，并且来自东方的经验显示出有前景的培训结果。在西方，通过学徒制与逐步接触相结合的综合培训模式，包括离体和活体动物实践培训，可能是最佳方法。目前有多种 ESD 培训方法，都旨在提供进行安全 ESD 所需的经验。尽管东西方的培训风格存在差异，但改良的学徒模式可能会带来更有效和更好的培训结果。现有的技术为增强 ESD 培训提供了环境。
