{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T17:40:05Z","timestamp":1754070005405,"version":"3.41.2"},"reference-count":19,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,10]]},"abstract":"<jats:sec>\n            <jats:title>Objective<\/jats:title>\n            <jats:p>An increasing use of endoscopic submucosal dissection (ESD) has been reported in Western countries, although some differences in training schemes and outcomes have been described. We aimed to report the training model, implementation, and outcomes of ESD in Portugal.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>All endoscopists trained at our center from our country (<jats:italic toggle=\"yes\">n<\/jats:italic> = 9) were invited to a survey regarding: (a) training period; (b) ESD outcomes and (c) implementation of ESD in each respective center.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>All endoscopists completed the survey. Learning ESD was centered on human ESD assistance in a high-volume center during a median time of 6 months and complemented mainly by hands-on courses (89%). During the surveyed period, a total of 1229 ESD were performed, mostly in gastric locations (74%). Median complete R0 and curative resection rate were 92% (IQR, 81\u201396.8) and 87% (IQR, 74\u201393.3), respectively, and median perforation rate was 0.89% (IQR, 0.25\u20136.22). The main limitations encountered during the implementation of ESD were related to the lack of initial mentoring or insufficient expertise to progress to more difficult lesions.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>Learning ESD through participation in hands-on courses and visiting high-volume centers seems to be adequate to achieve a good competence at the initial stage of ESD, which in fact is in consonance with the European Society of Gastrointestinal Endoscopy recommendations. However, mentoring is essential for technical progression, and this represents the fundamental barrier during the adoption of ESD, which may be overcome by increasing hands-on training in animal or artificial simulators, but preferably with the implementation of a structured training program.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/meg.0000000000002426","type":"journal-article","created":{"date-parts":[[2022,9,5]],"date-time":"2022-09-05T06:00:40Z","timestamp":1662357640000},"page":"1042-1046","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Endoscopic submucosal dissection: a country dissemination experience and outcomes"],"prefix":"10.1097","volume":"34","author":[{"given":"Marta","family":"Rodr\u00edguez-Carrasco","sequence":"first","affiliation":[{"name":"Gastroenterology Department, Portuguese Oncology Institute of Porto"}]},{"given":"Diogo","family":"Lib\u00e2nio","sequence":"additional","affiliation":[{"name":"Gastroenterology Department, Portuguese Oncology Institute of Porto"},{"name":"MEDCIDS - Department of Community Medicine, Health Information and Decision, Faculty of Medicine, University of Porto"}]},{"given":"Pedro","family":"Pimentel-Nunes","sequence":"additional","affiliation":[{"name":"Gastroenterology Department, Portuguese Oncology Institute of Porto"},{"name":"MEDCIDS - Department of Community Medicine, Health Information and Decision, Faculty of Medicine, University of Porto"},{"name":"Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto"}]},{"given":"Pedro","family":"Barreiro","sequence":"additional","affiliation":[{"name":"Gastroenterology Department, Lisboa Ocidental Hospital Center, Egas Moniz Hospital"},{"name":"Gastroenterology Department, Lus\u00edadas Hospital, Lisbon"}]},{"given":"Anibal","family":"Ferreira","sequence":"additional","affiliation":[{"name":"Gastroenterology Department, Hospital of Braga, Braga"}]},{"given":"Ricardo","family":"K\u00fcttner-Magalh\u00e3es","sequence":"additional","affiliation":[{"name":"Gastroenterology Department, Porto University Hospital Center"},{"name":"Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto"}]},{"given":"Rolando","family":"Pinho","sequence":"additional","affiliation":[{"name":"Gastroenterology Department, Vila Nova de Gaia Hospital Center, Vila Nova de Gaia"}]},{"given":"Pedro","family":"Boal Carvalho","sequence":"additional","affiliation":[{"name":"Gastroenterology Department, Senhora da Oliveira Hospital, Guimar\u00e3es"},{"name":"Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga"},{"name":"ICVS\/3B\u2019s, PT Government Associate Laboratory, Braga\/Guimar\u00e3es"}]},{"given":"Miguel","family":"Areia","sequence":"additional","affiliation":[{"name":"Gastroenterology Department, Portuguese Oncology Institute of Coimbra, Coimbra"}]},{"given":"Jorge","family":"Lage","sequence":"additional","affiliation":[{"name":"Gastroenterology Department, Tr\u00e1s-os-Montes e Alto Douro Hospital Center, Vila Real"}]},{"given":"Miguel","family":"Serrano","sequence":"additional","affiliation":[{"name":"Gastroenterology Department, Portuguese Oncology Institute of Lisbon, Lisbon, Portugal"}]},{"given":"Jo\u00e3o","family":"Silva","sequence":"additional","affiliation":[{"name":"Gastroenterology Department, Portuguese Oncology Institute of Lisbon, Lisbon, Portugal"}]},{"given":"Ant\u00f3nio","family":"Dias-Pereira","sequence":"additional","affiliation":[{"name":"Gastroenterology Department, Portuguese Oncology Institute of Lisbon, Lisbon, Portugal"}]},{"given":"Laura","family":"Carvalho","sequence":"additional","affiliation":[{"name":"Gastroenterology Department, Tr\u00e1s-os-Montes e Alto Douro Hospital Center, Vila Real"}]},{"given":"Ana Teresa","family":"Cadime","sequence":"additional","affiliation":[{"name":"Gastroenterology Department, Portuguese Oncology Institute of Coimbra, Coimbra"}]},{"given":"Jos\u00e9","family":"Cotter","sequence":"additional","affiliation":[{"name":"Gastroenterology Department, Senhora da Oliveira Hospital, Guimar\u00e3es"},{"name":"Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga"},{"name":"ICVS\/3B\u2019s, PT Government Associate Laboratory, Braga\/Guimar\u00e3es"}]},{"given":"Jo\u00e3o","family":"Carvalho","sequence":"additional","affiliation":[{"name":"Gastroenterology Department, Vila Nova de Gaia Hospital Center, Vila Nova de Gaia"}]},{"given":"Isabel","family":"Pedroto","sequence":"additional","affiliation":[{"name":"Gastroenterology 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