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Background and Study Aim: Adoption of endoscopic submucosal dissection (ESD) in Western countries has been limited by the difficulty in learning the procedure. Although a porcine model is commonly used for ESD training, without expert guidance the procedure is difficult to master. The availability of Western ESD experts is limited, and expert supervision through a remote video-based system may be a practical method for Western endoscopists to learn ESD. The aim of this study was to assess the value of video-based remote evaluation in supervising ESD training.Methods: Two Western endoscopists performed ESD training procedures in an ex vivo porcine model at least every 2 weeks until competency was achieved. Competency was defined as consistent en bloc resection of a 3-cm area within 30 minutes, and without perforation, using the proper ESD technique. A Japanese ESD expert at the National Cancer Center in Tokyo, Japan, analyzed the training videos, scored them, and provided written feedback for improvement after each training session and before the trainee's next training session.Results: Endoscopist 1 reached competency at 23 procedures and endoscopist 2 reached competency at 25 procedures. No difference in skill improvement between the two endoscopists was noted. One trainee subsequently completed eight ESD procedures in patients, with curative en bloc resection and no complications.Conclusion: A standardized ESD training program including educational presentations/videos and preclinical animal training with expert guidance through a remote video-based system is an effective tool for learning ESD techniques in preparation for performing the procedure in humans. [ABSTRACT FROM AUTHOR]

Background: The global epidemiological situation of gastric cancer has changed considerably over time, and it is essential to understand the epidemiological trends and future perspectives of gastric cancer., Summary: Although gastric cancer was common in the United States less than a century previously, it is no longer common in this country. Currently, over 60% of gastric cancers are found in Eastern Asia. In some Eastern Asian countries such as Japan and Korea, population-based gastric cancer screening has been conducted using upper gastrointestinal endoscopy or radiography to lower gastric cancer mortality. Due to earlier detection of gastric cancer, the survival of patients with gastric cancer is more favorable in these countries than in other Western countries. Even in Eastern Asia, a remarkable decrease in the age-standardized incidence and mortality of gastric cancer has been observed. This downward trend is mainly due to the reduced Helicobacter pylori infection, and this trend is considered to continue. Nevertheless, both the absolute number of incident cases and deaths of gastric cancer are still increasing at present due to the aging population. For the time being, the management of gastric cancer in elderly population is a critical issue in Eastern Asia. The absolute numbers of gastric cancer cases and deaths are believed to peak in the near future, following the decreasing age-standardized incidence and mortality. Key Messages: After a long period, gastric cancer may become a rare cancer even in Eastern Asia, and new efficient approaches for its prevention, screening, and treatment are warranted., (© 2021 S. Karger AG, Basel.)

Background: Although the incidence and mortality have decreased, gastric cancer (GC) is still a public health issue globally. An international study reported higher survival in Korea and Japan than other countries, including the United States. We examined the determinant factors of the high survival in Japan compared with the United States., Methods: We analysed data on 78,648 cases from the nationwide GC registration project, the Japanese Gastric Cancer Association (JGCA), from 2004-2007 and compared them with 16,722 cases from the Surveillance, Epidemiology, and End Results Program (SEER), a United States population-based cancer registry data from 2004-2010. We estimated 5-year relative survival and applied a multivariate excess hazard model to compare the two countries, considering the effect of number of lymph nodes (LNs) examined., Results: Five-year relative survival in Japan was 81.0%, compared with 45.0% in the United States. After controlling for confounding factors, we still observed significantly higher survival in Japan. Among N2 patients, a higher number of LNs examined showed better survival in both countries. Among N3 patients, the relationship between number of LNs examined and differences in survival between the two countries disappeared., Conclusion: Although the wide differences in GC survival between Japan and United States can be largely explained by differences in the stage at diagnosis, the number of LNs examined may also help to explain the gaps between two countries, which is related to stage migration.