{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T02:02:12Z","timestamp":1768442532035,"version":"3.49.0"},"reference-count":65,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T00:00:00Z","timestamp":1768348800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Leonie-Wild Foundation\/Eppelheim, Germany"},{"name":"Experimental ESD Training Program"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Endoscopic submucosal dissection (ESD) is a state-of-the-art en bloc resection for early gastro-intestinal cancers and precursors developed and validated in Japan. Western expertise with this complex technique remains limited. Tutored training might be optimal for patients and ESD learning. We established ESD tutoring courses led by experienced Japanese experts to provide (i) optimal long-term curative outcomes and low complication rates for patients and (ii) hands-on training on difficult lesions for European endoscopists under direct expert supervision. Methods: Prospective data from 2011 to 2015 (follow-up to 12\/2024) were analyzed. A total of 118 neoplasms (50% HGIEN and cancer) in 101 patients (median age 68 [37\u201391] years; 38% with significant comorbidities) were treated with expert or tutored ESD. Japanese experts performed 28 ESDs, while 22 trained beginners conducted 90 supervised procedures on difficult lesions during 5 live and 20 tutoring events (1\u20134 days each). Results: Analysis of the complete data showed curative and en bloc resection rates of 88% and 95%, respectively, with no recurrence after R0 resections during a median follow-up of 9.8 [1.5\u201314.9] years. Long-term survival remained recurrence-free after endoscopic resection of 3 recurrent adenomas (at R1\/Rx) and curative surgery\/2nd ESD for 5 non-curative ESDs. Adverse events occurred in 9.3% without emergency surgery or 30-day mortality. Comparing expert-only vs. tutored ESD procedures, beginners correctly applied curative ESD indications in 94% of 118 neoplasms. Experts resected larger lesions (22 cm2) at a rate of 9.3 cm2\/h in 121 min. Tutored beginners achieved a 75% [25\u2013100] self-completion rate on 33% smaller lesions in 112 min. Conclusions: ESD tutoring courses led by Japanese experts ensure excellent patient outcomes and standardized procedural training. This model may foster professional ESD performance across European referral centers.<\/jats:p>","DOI":"10.3390\/jcm15020675","type":"journal-article","created":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T15:12:04Z","timestamp":1768403524000},"page":"675","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical Endoscopic Submucosal Dissection of Trainees Tutored by Experts\u2014ESGE Endorsed Courses and Live Endoscopic Events 2011\u20132015"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9155-5762","authenticated-orcid":false,"given":"Daniel","family":"Neureiter","sequence":"first","affiliation":[{"name":"Institute of Pathology, University Hospital, Paracelsus Medical University, 5020 Salzburg, Austria"}]},{"given":"Naohisa","family":"Yahagi","sequence":"additional","affiliation":[{"name":"Division of Research and Development for Minimally Invasive Treatment, Cancer Center, School of Medicine, Keio University, Shinjuku-ku, Tokyo 160-8582, Japan"}]},{"given":"Tsuneo","family":"Oyama","sequence":"additional","affiliation":[{"name":"Department of Endoscopy, Saku Central Hospital Advanced Care Center, Saku 3400-28, Japan"}]},{"given":"Takashi","family":"Toyonaga","sequence":"additional","affiliation":[{"name":"Department of Endoscopy, Kobe University Hospital, Kobe 650-0017, Japan"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5403-9478","authenticated-orcid":false,"given":"Tobias","family":"Kiesslich","sequence":"additional","affiliation":[{"name":"Department of Medicine I, University Hospital, Paracelsus Medical University, 5020 Salzburg, Austria"},{"name":"Center for Physiology, Pathophysiology and Biophysics, Institute of Physiology and Pathophysiology, Paracelsus Medical University, 5020 Salzburg, Austria"}]},{"given":"Andrej","family":"Wagner","sequence":"additional","affiliation":[{"name":"Department of Medicine I, University Hospital, Paracelsus Medical University, 5020 Salzburg, Austria"},{"name":"Department of Medicine-Gastroenterology, Klinikum SOB, 83435 Bad Reichenhall, Germany"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1058-7867","authenticated-orcid":false,"given":"Franz Ludwig","family":"Dumoulin","sequence":"additional","affiliation":[{"name":"Innere Medizin\/Gastroenterologie, Gemeinschaftskrankenhaus Bonn, Prinz Albert Str. 40, 53113 Bonn, Germany"}]},{"given":"Alexander","family":"Ziachehabi","sequence":"additional","affiliation":[{"name":"Department of Medicine IV, Ordensklinikum Linz\u2014Elisabethinen, 4020 Linz, Austria"}]},{"given":"Hans-Peter","family":"Allgaier","sequence":"additional","affiliation":[{"name":"Department of Medicine, Evangelisches Diakoniekrankenhaus, 79110 Freiburg, Germany"}]},{"given":"Michael","family":"Anzinger","sequence":"additional","affiliation":[{"name":"Department of Medicine I, Krankenhaus der Barmherzigen Br\u00fcder, 80639 Munich, Germany"}]},{"given":"Gerhard","family":"Kleber","sequence":"additional","affiliation":[{"name":"Department of Medicine I, Ostalb Klinikum Aalen, 73428 Aalen, Germany"}]},{"given":"Hans","family":"Seifert","sequence":"additional","affiliation":[{"name":"Department of Medicine\u2013Gastroenterology, University Hospital Oldenburg, 26129 Oldenburg, Germany"}]},{"given":"Alberto","family":"Herreros de Tejada","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Puerta de Hierro University Hospital, 28222 Madrid, Spain"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9056-8844","authenticated-orcid":false,"given":"Ingo","family":"Steinbr\u00fcck","sequence":"additional","affiliation":[{"name":"Department of Medicine, Evangelisches Diakoniekrankenhaus, 79110 Freiburg, Germany"},{"name":"Department of Gastroenterology, Asklepios Klinikum, Hamburg-Altona, 22763 Hamburg, Germany"}]},{"given":"Barbara","family":"Tribl","sequence":"additional","affiliation":[{"name":"Department of Medicine III, University Hospital AKH Wien, 1090 Vienna, Austria"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4518-2146","authenticated-orcid":false,"given":"Alberto","family":"Tringali","sequence":"additional","affiliation":[{"name":"Endoscopia Digestiva, Ospedale Metropolitano Niguarda, 20162 Milan, Italy"}]},{"given":"Josef","family":"Holzinger","sequence":"additional","affiliation":[{"name":"Division Endoscopy, Department of Surgery, University Hospital, Paracelsus Medical University, 5020 Salzburg, Austria"}]},{"given":"Alanna","family":"Ebigbo","sequence":"additional","affiliation":[{"name":"Department of Medicine, St Josef Hospital, Ruhr University Bochum, 44801 Bochum, Germany"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0614-0576","authenticated-orcid":false,"given":"Jo\u00e3o","family":"Santos-Antunes","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, University Hospital S\u00e3o Jo\u00e3o, 4200-319 Porto, Portugal"}]},{"given":"Juergen","family":"Hochberger","sequence":"additional","affiliation":[{"name":"Department of Medicine-Gastroenterology, Charit\u00e9 Universit\u00e4tsmedizin, 13353 Berlin, Germany"}]},{"given":"Sergey V.","family":"Kantsevoy","sequence":"additional","affiliation":[{"name":"Institute for Digestive Health and Liver Disease, Mercy Medical Center, University of Maryland, Baltimore, MD 21202, USA"}]},{"given":"Mathieu","family":"Pioche","sequence":"additional","affiliation":[{"name":"Gastroenterology and Endoscopy Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, 5 Pl. d\u2019Arsonval, 69003 Lyon, France"}]},{"given":"Thierry","family":"Ponchon","sequence":"additional","affiliation":[{"name":"Gastroenterology and Endoscopy Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, 5 Pl. d\u2019Arsonval, 69003 Lyon, France"}]},{"given":"Frieder","family":"Berr","sequence":"additional","affiliation":[{"name":"Department of Medicine I, University Hospital, Paracelsus Medical University, 5020 Salzburg, Austria"},{"name":"Center for Physiology, Pathophysiology and Biophysics, Institute of Physiology and Pathophysiology, Paracelsus Medical University, 5020 Salzburg, Austria"}]},{"name":"ESD Tutoring Training Group","sequence":"additional","affiliation":[]}],"member":"1968","published-online":{"date-parts":[[2026,1,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1111\/j.1443-1661.2010.01005.x","article-title":"Learning curve for endoscopic submucosal dissection of large colorectal tumors","volume":"22","author":"Hotta","year":"2010","journal-title":"Dig. 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