A survey of physician training and credentialing in endoscopic submucosal dissection in the United States

Abstract

Background: Endoscopic submucosal dissection (ESD) is technically challenging, has a longer learning curve and a greater complication rate than most new endoscopic procedures. Formal training and credentialing guidelines for ESD are currently lacking in the United States (US).

Aim: To survey ESD experts across the US to determine their learning process and obtain their opinion on how training and credentialing for ESD should develop.

Design: Anonymous electronic survey.

Subjects: ASGE members who are practicing US endoscopists.

Methods: The survey was developed by iterative revisions of questions administered to three investigators who have been performing ESD for > 5 years. The final survey was distributed electronically to US endoscopists who had previously attended ESD expert conferences.

Results: Thirty-five (58.3%) of 60 practicing ESD experts responded to the survey. A majority (91%) were in university-based, community, or tertiary care hospitals. All practitioners practiced on porcine explants and observed live ESD procedures as part of the training. Out of the participants, 75.8% received formal supervised hands-on training on porcine explants and/or humans before performing ESD independently. Fifty percent indicated that their facility had written guidelines specifically for ESD credentialing. Four out of 5 felt that credentialing requirements should include attending weekend ESD courses, observing live procedures, practicing on explants, and advanced endoscopic training in interventional endoscopy such as an additional year of fellowship.

Limitations: Survey completion rate of 58.3%.

Conclusion: ESD training should include practicing on explants, observation of live procedures, training in interventional endoscopy, and attending educational courses. Credentialing guidelines for ESD based on expert opinion need to be developed in the US.

Keywords: Endoscopic submucosal dissection; Endoscopy procedure credentialing; Endoscopy training.