Implementation of endoscopic submucosal dissection in Europe: survey after 10 ESD Expert Training Workshops, 2009 to 2018

Tsuneo Oyama; Naohisa Yahagi; Thierry Ponchon; Tobias Kiesslich; Andrej Wagner; Takashi Toyonaga; Toshio Uraoka; Akiko Takahashi; Alexander Ziachehabi; Daniel Neureiter; Maria Fuschlberger; Franz Schachinger; Hans Seifert; Georg Kaehler; Alexandr Mitrakov; Sergey V. Kantsevoy; Helmut Messmann; Juergen Hochberger; Frieder Berr; the ESD Workshop Training Group

doi:10.1016/j.igie.2023.08.004

Implementation of endoscopic submucosal dissection in Europe: survey after 10 ESD Expert Training Workshops, 2009 to 2018

Tsuneo Oyama
, Naohisa Yahagi
, Thierry Ponchon
, Tobias Kiesslich
, Andrej Wagner
, Takashi Toyonaga
, Toshio Uraoka
, Akiko Takahashi
, Alexander Ziachehabi
, Daniel Neureiter
, Maria Fuschlberger
, Franz Schachinger
, Hans Seifert
, Georg Kaehler
, Alexandr Mitrakov
, Sergey V. Kantsevoy
, Helmut Messmann
, Juergen Hochberger
, Frieder Berr^*
, the ESD Workshop Training Group

^*Corresponding author for this work

Saku Central Hospital
Keio University
Université de Lyon
Paracelsus Private Medical University
Kobe University
Gunma University
Johannes Kepler University Linz
Veterinary Practice
Klinikum Oldenburg
Heidelberg University
Privolzhskiy Research Medical University
University of Maryland, Baltimore
University Hospital Augsburg
Vivantes Netzwerk für Gesundheit GmbH
Clinique de l‘Anjou
LeopoldinuMED Hall in Tirol
Hôpital Paris Saint-Joseph
Diakonie KH Freiburg
Ziekenhuis Nij Smellinghe, Drachten
Sana
Mayo Clinic Scottsdale, AZ
University of Zurich
Istanbul Aydin University
Townsville University Hospital
Kliniken Böblingen
Immobilienverwaltung Schulgemeindeverband Spittal a. d. Drau KG
KRH Klinikum Siloah
Hirslanden Klinik Linde
St. Elisabeth-Krankenhaus Köln-Hohenlind

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Abstract

Background and Aims: Adoption of the endoscopic submucosal dissection (ESD) technique for early GI cancer from Japan requires expert-supervised experimental training before unsupervised implementation of clinical ESD. The aim of this study was to evaluate unsupervised implementation of ESD intention-to-treat (ie, any resection planned and started as en bloc ESD). Methods: ESD workshops (in vivo porcine model) lasted 3.3 days, including a 1-day theory seminar, for 177 participants from 135 Western referral centers. A questionnaire was sent to the senior participant of all 135 centers. This cross-sectional questionnaire survey included main outcome measurements such as performance, organ distribution, and severe adverse events of ESD intention-to-treat. Results: Feedback was received from 113 centers (84%): 73 (54%) ESD centers and 40 centers (30%) with zero ESDs. Ten (7%) had published ESDs; no feedback was received from 12 (9%) centers with unknown status. Altogether, 83 centers (61.5%) performed ESDs: 21 (16%) had >150 ESDs (professional category), 33 (24%) had 31 to 150 ESDs (competent category), and 29 (21.5%) had ≤30 ESDs (initial learning category). Most implemented ESD centers (91% [72 of 79]) were analyzed: centers on initial learning (420 ESD) compared with centers with >30 ESDs (5676 ESDs) performed en bloc ESDs in 64% versus 84%, hybrid ESD in 26% versus 11%, and piecemeal EMR in 10% versus 5.2%. The majority of ESDs (66%-68%) performed were in the colorectum, with a low risk overall (30-day mortality, 0.03%; surgical repair, 3.5% vs 1.7%) and satisfactory outcome (oncosurgery, 7.4% vs 5.2%; local recurrence, 1.5% vs 0.3%). Conclusions: Beyond guideline recommendations, unsupervised implementation of ESD was successful in the colorectum with a step-up approach. Western ESD centers must now aim for professional (ie, >80%) curative ESD.

Original language	English
Pages (from-to)	472-480.e5
Journal	iGIE
Volume	2
Issue number	4
DOIs	https://doi.org/10.1016/j.igie.2023.08.004
Publication status	Published - 1 Dec 2023

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SDG 3 Good Health and Well-being

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Oyama, T., Yahagi, N., Ponchon, T., Kiesslich, T., Wagner, A., Toyonaga, T., Uraoka, T., Takahashi, A., Ziachehabi, A., Neureiter, D., Fuschlberger, M., Schachinger, F., Seifert, H., Kaehler, G., Mitrakov, A., Kantsevoy, S. V., Messmann, H., Hochberger, J., Berr, F., & the ESD Workshop Training Group (2023). Implementation of endoscopic submucosal dissection in Europe: survey after 10 ESD Expert Training Workshops, 2009 to 2018. iGIE, 2(4), 472-480.e5. https://doi.org/10.1016/j.igie.2023.08.004

@article{f9b651239dfe405bb757caa473a9bda8,

title = "Implementation of endoscopic submucosal dissection in Europe: survey after 10 ESD Expert Training Workshops, 2009 to 2018",

abstract = "Background and Aims: Adoption of the endoscopic submucosal dissection (ESD) technique for early GI cancer from Japan requires expert-supervised experimental training before unsupervised implementation of clinical ESD. The aim of this study was to evaluate unsupervised implementation of ESD intention-to-treat (ie, any resection planned and started as en bloc ESD). Methods: ESD workshops (in vivo porcine model) lasted 3.3 days, including a 1-day theory seminar, for 177 participants from 135 Western referral centers. A questionnaire was sent to the senior participant of all 135 centers. This cross-sectional questionnaire survey included main outcome measurements such as performance, organ distribution, and severe adverse events of ESD intention-to-treat. Results: Feedback was received from 113 centers (84\%): 73 (54\%) ESD centers and 40 centers (30\%) with zero ESDs. Ten (7\%) had published ESDs; no feedback was received from 12 (9\%) centers with unknown status. Altogether, 83 centers (61.5\%) performed ESDs: 21 (16\%) had >150 ESDs (professional category), 33 (24\%) had 31 to 150 ESDs (competent category), and 29 (21.5\%) had ≤30 ESDs (initial learning category). Most implemented ESD centers (91\% [72 of 79]) were analyzed: centers on initial learning (420 ESD) compared with centers with >30 ESDs (5676 ESDs) performed en bloc ESDs in 64\% versus 84\%, hybrid ESD in 26\% versus 11\%, and piecemeal EMR in 10\% versus 5.2\%. The majority of ESDs (66\%-68\%) performed were in the colorectum, with a low risk overall (30-day mortality, 0.03\%; surgical repair, 3.5\% vs 1.7\%) and satisfactory outcome (oncosurgery, 7.4\% vs 5.2\%; local recurrence, 1.5\% vs 0.3\%). Conclusions: Beyond guideline recommendations, unsupervised implementation of ESD was successful in the colorectum with a step-up approach. Western ESD centers must now aim for professional (ie, >80\%) curative ESD.",

author = "Tsuneo Oyama and Naohisa Yahagi and Thierry Ponchon and Tobias Kiesslich and Andrej Wagner and Takashi Toyonaga and Toshio Uraoka and Akiko Takahashi and Alexander Ziachehabi and Daniel Neureiter and Maria Fuschlberger and Franz Schachinger and Hans Seifert and Georg Kaehler and Alexandr Mitrakov and Kantsevoy, \{Sergey V.\} and Helmut Messmann and Juergen Hochberger and Frieder Berr and \{the ESD Workshop Training Group\} and Ulrich Halm and Heinrich Schulz and Edouard Chabrun and Franck Cholet and Henrik Thorlacius and Franz-Ludwig Dumoulin and \{Herreros de Tejada\}, Alberto and Cezary {\L}ozinski and Fabrice Caillol and Michal Spychalski and Santos-Antunes, \{Jo{\~a}o C.\} and Manfred Lutz and Katrin Bermoser and Andreas Sch{\"a}fer and Alfried-Krupp Krankenhaus and Yann LeBaleur and Harold Jacob and Hans-Peter Allgaier and Gerhard Kleber and Ingo Steinbr{\"u}ck and Alberto Tringali and Thomas Flatz and Christian {\"O}sterreicher and Anton Glas and Robert Schroder and Achim Lutterer and Edris Wedi and Michael Anzinger and Philip Boger and Stepan Such{\'a}nek and Arthur Laqui{\`e}re and Sarveson Rajkumar and Maciej Rupinski and Terry Jue and Mohamed Barawi and Christoph Schlag and Oliver M{\"o}schler and Sandro Sferrazza and Boris Pekarek and Poyrazoglu, \{Orhan Kursat\} and Bulent Baran and Andreas Mayer and Barbara Tribl and Martin Goetz and Dieter Plamenig and Tilman Pickartz and Chris Hayward and Frank Gr{\"u}nhage and Tarek Qutob and Tom Seerden and Volker Schmitz and Reiner Wiest and Arthur Hoffman and Henrik Horvath and Edi Viale and Michaela LaRoche and Jan Peveling-Oberhag and Maridi Aerts and Eyal Gal and Daniel Doykov and David Allerstorfer and Gerd Bodlaj and Romualdas Maskelis and Varvara Vassiljeva and Nikos Kapetanakis and Beate Appenrodt and Miguel Moura and Bastiaansen, \{Barbara A.\} and Neven Barsic and Vinzent Zimmer",

year = "2023",

month = dec,

day = "1",

doi = "10.1016/j.igie.2023.08.004",

language = "English",

volume = "2",

pages = "472--480.e5",

journal = "iGIE",

issn = "2949-7086",

publisher = "Elsevier B.V.",

number = "4",

}

Oyama, T, Yahagi, N, Ponchon, T, Kiesslich, T, Wagner, A, Toyonaga, T, Uraoka, T, Takahashi, A, Ziachehabi, A, Neureiter, D, Fuschlberger, M, Schachinger, F, Seifert, H, Kaehler, G, Mitrakov, A, Kantsevoy, SV, Messmann, H, Hochberger, J, Berr, F & the ESD Workshop Training Group 2023, 'Implementation of endoscopic submucosal dissection in Europe: survey after 10 ESD Expert Training Workshops, 2009 to 2018', iGIE, vol. 2, no. 4, pp. 472-480.e5. https://doi.org/10.1016/j.igie.2023.08.004

TY - JOUR

T1 - Implementation of endoscopic submucosal dissection in Europe

T2 - survey after 10 ESD Expert Training Workshops, 2009 to 2018

AU - Oyama, Tsuneo

AU - Yahagi, Naohisa

AU - Ponchon, Thierry

AU - Kiesslich, Tobias

AU - Wagner, Andrej

AU - Toyonaga, Takashi

AU - Uraoka, Toshio

AU - Takahashi, Akiko

AU - Ziachehabi, Alexander

AU - Neureiter, Daniel

AU - Fuschlberger, Maria

AU - Schachinger, Franz

AU - Seifert, Hans

AU - Kaehler, Georg

AU - Mitrakov, Alexandr

AU - Kantsevoy, Sergey V.

AU - Messmann, Helmut

AU - Hochberger, Juergen

AU - Berr, Frieder

AU - the ESD Workshop Training Group

AU - Halm, Ulrich

AU - Schulz, Heinrich

AU - Chabrun, Edouard

AU - Cholet, Franck

AU - Thorlacius, Henrik

AU - Dumoulin, Franz-Ludwig

AU - Herreros de Tejada, Alberto

AU - Łozinski, Cezary

AU - Caillol, Fabrice

AU - Spychalski, Michal

AU - Santos-Antunes, João C.

AU - Lutz, Manfred

AU - Bermoser, Katrin

AU - Schäfer, Andreas

AU - Krankenhaus, Alfried-Krupp

AU - LeBaleur, Yann

AU - Jacob, Harold

AU - Allgaier, Hans-Peter

AU - Kleber, Gerhard

AU - Steinbrück, Ingo

AU - Tringali, Alberto

AU - Flatz, Thomas

AU - Österreicher, Christian

AU - Glas, Anton

AU - Schroder, Robert

AU - Lutterer, Achim

AU - Wedi, Edris

AU - Anzinger, Michael

AU - Boger, Philip

AU - Suchánek, Stepan

AU - Laquière, Arthur

AU - Rajkumar, Sarveson

AU - Rupinski, Maciej

AU - Jue, Terry

AU - Barawi, Mohamed

AU - Schlag, Christoph

AU - Möschler, Oliver

AU - Sferrazza, Sandro

AU - Pekarek, Boris

AU - Poyrazoglu, Orhan Kursat

AU - Baran, Bulent

AU - Mayer, Andreas

AU - Tribl, Barbara

AU - Goetz, Martin

AU - Plamenig, Dieter

AU - Pickartz, Tilman

AU - Hayward, Chris

AU - Grünhage, Frank

AU - Qutob, Tarek

AU - Seerden, Tom

AU - Schmitz, Volker

AU - Wiest, Reiner

AU - Hoffman, Arthur

AU - Horvath, Henrik

AU - Viale, Edi

AU - LaRoche, Michaela

AU - Peveling-Oberhag, Jan

AU - Aerts, Maridi

AU - Gal, Eyal

AU - Doykov, Daniel

AU - Allerstorfer, David

AU - Bodlaj, Gerd

AU - Maskelis, Romualdas

AU - Vassiljeva, Varvara

AU - Kapetanakis, Nikos

AU - Appenrodt, Beate

AU - Moura, Miguel

AU - Bastiaansen, Barbara A.

AU - Barsic, Neven

AU - Zimmer, Vinzent

PY - 2023/12/1

Y1 - 2023/12/1

N2 - Background and Aims: Adoption of the endoscopic submucosal dissection (ESD) technique for early GI cancer from Japan requires expert-supervised experimental training before unsupervised implementation of clinical ESD. The aim of this study was to evaluate unsupervised implementation of ESD intention-to-treat (ie, any resection planned and started as en bloc ESD). Methods: ESD workshops (in vivo porcine model) lasted 3.3 days, including a 1-day theory seminar, for 177 participants from 135 Western referral centers. A questionnaire was sent to the senior participant of all 135 centers. This cross-sectional questionnaire survey included main outcome measurements such as performance, organ distribution, and severe adverse events of ESD intention-to-treat. Results: Feedback was received from 113 centers (84%): 73 (54%) ESD centers and 40 centers (30%) with zero ESDs. Ten (7%) had published ESDs; no feedback was received from 12 (9%) centers with unknown status. Altogether, 83 centers (61.5%) performed ESDs: 21 (16%) had >150 ESDs (professional category), 33 (24%) had 31 to 150 ESDs (competent category), and 29 (21.5%) had ≤30 ESDs (initial learning category). Most implemented ESD centers (91% [72 of 79]) were analyzed: centers on initial learning (420 ESD) compared with centers with >30 ESDs (5676 ESDs) performed en bloc ESDs in 64% versus 84%, hybrid ESD in 26% versus 11%, and piecemeal EMR in 10% versus 5.2%. The majority of ESDs (66%-68%) performed were in the colorectum, with a low risk overall (30-day mortality, 0.03%; surgical repair, 3.5% vs 1.7%) and satisfactory outcome (oncosurgery, 7.4% vs 5.2%; local recurrence, 1.5% vs 0.3%). Conclusions: Beyond guideline recommendations, unsupervised implementation of ESD was successful in the colorectum with a step-up approach. Western ESD centers must now aim for professional (ie, >80%) curative ESD.

AB - Background and Aims: Adoption of the endoscopic submucosal dissection (ESD) technique for early GI cancer from Japan requires expert-supervised experimental training before unsupervised implementation of clinical ESD. The aim of this study was to evaluate unsupervised implementation of ESD intention-to-treat (ie, any resection planned and started as en bloc ESD). Methods: ESD workshops (in vivo porcine model) lasted 3.3 days, including a 1-day theory seminar, for 177 participants from 135 Western referral centers. A questionnaire was sent to the senior participant of all 135 centers. This cross-sectional questionnaire survey included main outcome measurements such as performance, organ distribution, and severe adverse events of ESD intention-to-treat. Results: Feedback was received from 113 centers (84%): 73 (54%) ESD centers and 40 centers (30%) with zero ESDs. Ten (7%) had published ESDs; no feedback was received from 12 (9%) centers with unknown status. Altogether, 83 centers (61.5%) performed ESDs: 21 (16%) had >150 ESDs (professional category), 33 (24%) had 31 to 150 ESDs (competent category), and 29 (21.5%) had ≤30 ESDs (initial learning category). Most implemented ESD centers (91% [72 of 79]) were analyzed: centers on initial learning (420 ESD) compared with centers with >30 ESDs (5676 ESDs) performed en bloc ESDs in 64% versus 84%, hybrid ESD in 26% versus 11%, and piecemeal EMR in 10% versus 5.2%. The majority of ESDs (66%-68%) performed were in the colorectum, with a low risk overall (30-day mortality, 0.03%; surgical repair, 3.5% vs 1.7%) and satisfactory outcome (oncosurgery, 7.4% vs 5.2%; local recurrence, 1.5% vs 0.3%). Conclusions: Beyond guideline recommendations, unsupervised implementation of ESD was successful in the colorectum with a step-up approach. Western ESD centers must now aim for professional (ie, >80%) curative ESD.

UR - https://www.scopus.com/pages/publications/85203003291

U2 - 10.1016/j.igie.2023.08.004

DO - 10.1016/j.igie.2023.08.004

M3 - Article

SN - 2949-7086

VL - 2

SP - 472-480.e5

JO - iGIE

JF - iGIE

IS - 4

ER -

Implementation of endoscopic submucosal dissection in Europe: survey after 10 ESD Expert Training Workshops, 2009 to 2018

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