Published online Oct 28, 2015. doi: 10.3748/wjg.v21.i40.11209
Peer-review started: June 8, 2015
First decision: July 20, 2015
Revised: August 6, 2015
Accepted: September 28, 2015
Article in press: September 30, 2015
Published online: October 28, 2015
Endoscopic submucosal dissection (ESD) has been invented in Japan to provide resection for cure of early cancer in the gastrointestinal tract. Professional level of ESD requires excellent staging of early neoplasias with image enhanced endoscopy (IEE) to make correct indications for ESD, and high skills in endoscopic electrosurgical dissection. In Japan, endodiagnostic and endosurgical excellence spread through personal tutoring of skilled endoscopists by the inventors and experts in IEE and ESD. To translocate this expertise to other continents must overcome two fundamental obstacles: (1) inadequate expectations as to the complexity of IEE and ESD; and (2) lack of suitable lesions and master-mentors for ESD trainees. Leading endoscopic mucosal resection-proficient endoscopists must pioneer themselves through the long learning curve to proficient ESD experts. Major referral centers for ESD must arise in Western countries on comparable professional level as in Japan. In the second stage, the upcoming Western experts must commit themselves to teach skilled endoscopists from other referral centers, in order to spread ESD in Western countries. Respect for patients with early gastrointestinal cancer asks for best efforts to learn endoscopic categorization of early neoplasias and skills for ESD based on sustained cooperation with the masters in Japan. The strategy is discussed here.
Core tip: Endoscopic submucosal dissection (ESD) was developed in Japan for curative resection of early cancer. But Western countries take very long without tutoring to establish ESD on a professional level. A two-fold, sequential learning curve is necessary for endoscopic staging, and for endoluminal surgery of early neoplasias. This will need a sequential strategy: (1) education for diagnostic skills in routine endoscopy and in educational programs; and (2) endoscopists proficient in endoscopic snaring techniques must train for ESD and pass an untutored learning curve to become proficient. Then, Western ESD experts must instruct endoscopists from referral centers in their country.