title: Impact of formal training in endoscopic submucosal dissection for early gastrointestinal cancer: A systematic review and a meta-analysis.
abstract: OBJECTIVE
  To summarize the clinical impact of a formal training for the effectiveness and safety of endoscopic submucosal dissection for gastrointestinal cancer.
  
  
  METHODS
  We searched databases including PubMed, EMBASE and the Cochrane Library and Science citation Index updated to August 2014 to include eligible articles. In the Meta-analysis, the main outcome measurements were en bloc resection rate, local recurrence rate (R0) and the incidence of procedure-related complications (perforation, bleeding).
  
  
  RESULTS
  En bloc resection was high for both, dissecting stomach tumors with an overall percentage of 93.2% (95%CI: 90.5-95.8) and dissecting colorectal tumors with an overall percentage of 89.4% (95%CI: 85.1-93.7). Although the number of studies reporting R0 resection (the dissected specimen was revealed free of tumor in both vertical and lateral margins) was small, the overall estimates for R0 resection were 81.4% (95%CI: 72-90.8) for stomach and 85.9% (95%CI: 77.5-95.5) for colorectal tumors, respectively. The analysis showed that the percentage of immediate perforation and bleeding were very low; 4.96 (95%CI: 3.6-6.3) and 1.4% (95%CI: 0.8-1.9) for colorectal tumors and 3.1% (95%CI: 2.0-4.1) and 4.8% (95%CI: 2.8-6.7) for stomach tumors, respectively.
  
  
  CONCLUSIONS
  In order to obtain the same rate of success of the analyzed studies it is a necessity to create training centers in the western countries during the "several years" of gastroenterology residence first only to teach EGC diagnose and second only to train endoscopic submucosal dissection.
authors.affiliation: Miguel A Tanimoto, M Lourdes Guerrero, Jonathan Aguirre-Valadez, Elisa Gomez, Carlos Moctezuma-Velazquez, Jose A Estradas-Trujillo, Miguel A Valdovinos, Luis F Uscanga, National Institute of Medical Sciences and Nutrition Salvador Zubiran, 14000 Mexico City, Mexico.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Tanimoto
authors.affiliation: Miguel A Tanimoto, M Lourdes Guerrero, Jonathan Aguirre-Valadez, Elisa Gomez, Carlos Moctezuma-Velazquez, Jose A Estradas-Trujillo, Miguel A Valdovinos, Luis F Uscanga, National Institute of Medical Sciences and Nutrition Salvador Zubiran, 14000 Mexico City, Mexico.
authors.forename: M Lourdes
authors.initials: ML
authors.lastname: Guerrero
authors.affiliation: Miguel A Tanimoto, M Lourdes Guerrero, Jonathan Aguirre-Valadez, Elisa Gomez, Carlos Moctezuma-Velazquez, Jose A Estradas-Trujillo, Miguel A Valdovinos, Luis F Uscanga, National Institute of Medical Sciences and Nutrition Salvador Zubiran, 14000 Mexico City, Mexico.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Morita
authors.affiliation: Miguel A Tanimoto, M Lourdes Guerrero, Jonathan Aguirre-Valadez, Elisa Gomez, Carlos Moctezuma-Velazquez, Jose A Estradas-Trujillo, Miguel A Valdovinos, Luis F Uscanga, National Institute of Medical Sciences and Nutrition Salvador Zubiran, 14000 Mexico City, Mexico.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Aguirre-Valadez
authors.affiliation: Miguel A Tanimoto, M Lourdes Guerrero, Jonathan Aguirre-Valadez, Elisa Gomez, Carlos Moctezuma-Velazquez, Jose A Estradas-Trujillo, Miguel A Valdovinos, Luis F Uscanga, National Institute of Medical Sciences and Nutrition Salvador Zubiran, 14000 Mexico City, Mexico.
authors.forename: Elisa
authors.initials: E
authors.lastname: Gomez
authors.affiliation: Miguel A Tanimoto, M Lourdes Guerrero, Jonathan Aguirre-Valadez, Elisa Gomez, Carlos Moctezuma-Velazquez, Jose A Estradas-Trujillo, Miguel A Valdovinos, Luis F Uscanga, National Institute of Medical Sciences and Nutrition Salvador Zubiran, 14000 Mexico City, Mexico.
authors.forename: Carlos
authors.initials: C
authors.lastname: Moctezuma-Velazquez
authors.affiliation: Miguel A Tanimoto, M Lourdes Guerrero, Jonathan Aguirre-Valadez, Elisa Gomez, Carlos Moctezuma-Velazquez, Jose A Estradas-Trujillo, Miguel A Valdovinos, Luis F Uscanga, National Institute of Medical Sciences and Nutrition Salvador Zubiran, 14000 Mexico City, Mexico.
authors.forename: Jose A
authors.initials: JA
authors.lastname: Estradas-Trujillo
authors.affiliation: Miguel A Tanimoto, M Lourdes Guerrero, Jonathan Aguirre-Valadez, Elisa Gomez, Carlos Moctezuma-Velazquez, Jose A Estradas-Trujillo, Miguel A Valdovinos, Luis F Uscanga, National Institute of Medical Sciences and Nutrition Salvador Zubiran, 14000 Mexico City, Mexico.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Valdovinos
authors.affiliation: Miguel A Tanimoto, M Lourdes Guerrero, Jonathan Aguirre-Valadez, Elisa Gomez, Carlos Moctezuma-Velazquez, Jose A Estradas-Trujillo, Miguel A Valdovinos, Luis F Uscanga, National Institute of Medical Sciences and Nutrition Salvador Zubiran, 14000 Mexico City, Mexico.
authors.forename: Luis F
authors.initials: LF
authors.lastname: Uscanga
authors.affiliation: Miguel A Tanimoto, M Lourdes Guerrero, Jonathan Aguirre-Valadez, Elisa Gomez, Carlos Moctezuma-Velazquez, Jose A Estradas-Trujillo, Miguel A Valdovinos, Luis F Uscanga, National Institute of Medical Sciences and Nutrition Salvador Zubiran, 14000 Mexico City, Mexico.
authors.forename: Rikiya
authors.initials: R
authors.lastname: Fujita
keywords: Endoscopic submucosal dissection; Training