Introduction: In 2012, the American Society for Gastrointestinal Endoscopy (ASGE) established the official Advanced Endoscopy Fellowship (AEF) program match, supervised by the ASGE training committee, to serve as a platform connecting applicants and programs. Historically, advanced endoscopy fellowships offered endoluminal endoscopic procedures, including endoscopic retrograde cholangiopancreatography, endoscopic ultrasound, and endoscopic mucosal resection. To become designated as proficient, trainees needed to meet a minimum procedural volume. More recently, third space endoscopy procedures have evolved including endoscopic submucosal dissection (ESD) and peroral endoscopic myotomy (POEM). Multiple studies support that ESD proficiency requires a trainee perform a minimum of 50 gastric/esophageal as well as 50 colorectal dissections, for a total of at least 100 ESD procedures. We conducted a mirror study to reflect the present status of ESD training among the ASGE match programs.
Methods: 2023 ASGE AEF programs were reviewed from publicly available information posted on the ASGE website.
Results: Of the 78 AEF programs, 70 offer ESD training. The total number of ESD procedures per institution was 41.8±37 per year. Of these, the reported volume involving fellows’ hands-on experience was 17.8±24.6 procedures per year. The average number of physicians performing ESD was 1.4±0.7 per institution. Twenty-two of 70 programs perform >50 ESD procedures annually, with a median of 83.2±36.5 procedures per year. In these 22 programs, the fellows’ hands on experience was 33.3±34.5 procedures annually.
Discussion: ESD is an emerging endoscopic procedure for early GI tract malignancies. To be able to perform the procedure independently and safely, more than 100 supervised ESD procedures are required to achieve proficiency. Relative to other parts of the world, ESD in the United States is still an evolving procedural realm demanding close proctorship. Based on the current ASGE AEF data presented, a better understanding of the training process for ESD and third space endoscopy is necessary, with the potential development of standardized training requirements.
