Training to perform ESD in a regional hospital in Hong Kong

Early gastrointestinal tract tumor can be effectively treated by endoscopic submucosal dissection, which is gradually accepted as standard treatment in Hong Kong. The learning pathway of ESD in a regional hospital in Hong Kong is described.After attaining diagnostic and therapeutic endoscopy in Hong Kong and clinical attachement in Japan of ESD training, ESD was started with coaching by local expert in initial cases. Practice in porcine model, review with expert, post procedure review of videos and training courses were attended regularly to improve the technique and outcome.There were 15 resections carried out in 14 patients, including 8 gastric mucosal lesion, 2 gastric submucosal lesion and 5 esophageal lesions. All procedures were performed under general anaesthesia. A combination of dual knife, TT knife and /or IT2 knife was used. Mean operative time was 152minutes (45 to 292 mins). There was no perforation. There was one bleeding requiring endoscopic haemostasis. Post operative length of stay was 2 or 3 days. Curative resection is carried out in 60%, 2 patients were treated with salvage surgery while the 4with involved lateral margin by dysplasia (2 esophageal and 2 gastric) were followed up by endoscopy.Training, attendance of ESD workshop, coaching by local expert and continuous evaluation and refinement of own technique and result can lead to minimal level of competence required and continues improvement.