Training in advanced endoscopic resection techniques

Ricardo Küttner Magalhães

Ricardo Küttner Magalhães is specialist in gastroenterologist at CHUdSA and Associate Professor at the Institute of Biomedical Sciences Abel Salazar, University of Porto (ICBAS-UP).
He got his Ph.D. in Medical Sciences at ICBAS-UP in March 2022, under the supervision of Professor Arjun D. Koch, Professor Mário Dinis-Ribeiro and Professor Ricardo Marcos-Pinto.


The object of study of your doctoral thesis was training in advanced endoscopic resection techniques, including submucosal dissection. Can you briefly explain this technique?

Endoscopic submucosal dissection (ESD) is a technique that allows en bloc resection irrespective of lesion size and accurate histopathological assessment. It provides higher radical (R0) resection rates and lower local recurrence rates compared to conventional endoscopic mucosal resection (EMR). On the other hand, due to its complexity, ESD involves prolonged procedure times and an increased risk of adverse events.


What were the main study results?

ESD performance on animal models has been recognized as the simulation setting of choice, due to its perceived human similarity.

With our research, face, content and expert validity of the live porcine model in performing multiband EMR, esophageal and gastric ESD was established. Training in this model was considered very realistic compared to the human setting and highly appreciated as a learning tool. Consequently, adequate evidence was gathered to recommend its incorporation into formal teaching programs. Supporting this assumption, in a subsequent study in this model, complete resections, en bloc resections and ESD speed improved, as adverse events decreased, during consecutive procedures.

Furthermore, we realized that Western endoscopists had extensive endoscopic experience before starting ESD and the majority underwent training with animal models, which were considered very useful and deemed a prerequisite before clinical practice.

Finally, endoscopists attending dedicated ESD workshops were adequately skilled before human ESD initiation, complying with recommendations for training and appropriately implementing the technique in clinical practice. Importantly, we observed that structured training programs translated into clinical outcomes that exceed established standards, namely in the early clinical phase.


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