[Visiting Endoscopy Unit at SMC]

1. Program

2. How we teach endoscopy for beginners at SMC

3. Gastroscopy box simulator training (Boxim)

4. Description exercise (DEX) - DEX Quiz

5. Case-based discussions on gastric cancer

6. Case-based discussions on gastric ESD

7. Selected lectures on ESD

8. References

* URL : endotoday.com/endotoday/visiting_SMC.html


1. Program

Learning endoscopy is not easy. In order to become an endoscopy specialist, it usually takes two years of full-time training in a dedicated training center. However, a few months of training can be enough to learn the basic knowledge and skills for a primary clinic-level screening endoscopist.

At Samsung Medican Center, we prepared the box simulator (BOXIM) workshop and the description exercise (DEX) workshop for endoscopy beginners. The BOXIM workshop is a 4 hour gastroscopy hands-on training using Koken upper GI endoscopy simulator. The DEX workshop is a 3 hour course of lectures and description training. These programs are open not only to the physicians but also to the surgeons and family medicine doctors. They are Korean language programs, but English sessions can be organized upon request.

Schedule for one week basic endoscopy course is as follows.

One-week observation schedule (Students, General)
MonTueWedThurFri
AMG-BOXIM 1
(LJH)
G-ESD
(LH, MBH)
Colonoscopy
(KYH)
At main building F4
G-ESD
(MYW)
EGD, ablation
(LJH)
PMEGDG-ESD
(LJH)
G-ESD
(KJJ)
G-BOXIM 2
(LJH)
Colonoscopy
(JDK)

ESD training course (one week) is also available at Samsung Medical Center. It consists of (1) introductory lectures, (2) ESD observation, (3) ESD conference and ESD planning session, (4) Hands-on training using EndoGEL (artificial layer) or live pig.

If there are any questions, send me an e-mail to professor Lee at stomachlee@gmail.com.

* More information about observership program at SMC: https://www.samsunghospital.com/gb/language/english/education/observerShip.do

* Contact point: International Training Office (e-mail: dominique.cho@samsung.com)


2. How we teach endoscopy for beginners at SMC

SMC basic endoscopy training course (3 months)
Program1st month2nd month3rd month
On-line lecture


KSGE lectures 1-10 KSGE lectures 11-20
Staff lecture (1) Insertion
(2) Description
(3) Common GI disorders
One point lesson One point lesson
Book & Journal club Textbook reading with tutors Review the review Review the review
Description training 1, 2, 3, 4 5, 6, 7, 8 9, 10, 11, 12
Gastric cancers 1,000 Season 1 Season 2 Season 3
Weekly conference Endoscopy conference
GI conference
Endoscopy conference
GI conference
Endoscopy conference
GI conference
Observation and hands-on Weekly observation
Simulator training
Daily observation Hands-on
Others EndoTODAY
Topic presentation 1, 2, 3
EndoTODAY
Topic presentation 4, 5, 6
EndoTODAY
Topic presentation 7, 8, 9
Quiz 365

* Yearly program


3. Gastroscopy box simulator training (Boxim)

2019-1. 내시경 삽입법 BOXIM 시범 (부분)

Gastroscopy box simulator training guide

(Word version)


4. Description exercise (DEX) and DEX Quiz

You can learn how to describe endoscopic findings following the SMC style.

in English (2017-7-10)

in Korean (2019-2-9)

SMC style - (1) Location, (2) Size, (3) Major finding, (4) Minor findings, (5) Impression, (6) Classification

* Manual for description exercise (in Korean)

* Lectures for various topics (in Korean)


[Examples]

Example 1

1) Location

2) Size

3) Major finding

4) Minor findings

5) Impression

6) Classification


Example 2

1) Location

2) Size

3) Major finding

4) Minor findings

5) Impression

6) Classification


Example 3

1) Location

2) Size

3) Major finding

4) Minor findings

5) Impression

6) Classification

* Classification: endoscopic classification of chronic gastritis (in Korean)


Example 4

1) Location

2) Size

3) Major finding

4) Minor findings

5) Impression

6) Classification

* Terminology: folds of EGC, Case 1, Case 2


Example 5

1) Location

2) Size

3) Major finding

4) Minor findings

5) Impression

6) Classification


Example 6

1) Location

2) Size

3) Major finding

4) Minor findings

5) Impression

6) Classification


Example 7

1) Location

2) Size

3) Major finding

4) Minor findings

5) Impression

6) Classification


Example 8

1) Location

2) Size

3) Major finding

4) Minor findings

5) Impression

6) Classification


Example 9

1) Location

2) Size

3) Major finding

4) Minor findings

5) Impression

6) Classification


Example 10

1) Location: 30cm from the incisor teeth

2) Size

3) Major finding

4) Minor findings

5) Impression

6) Classification



Example 11

1) Location

2) Size

3) Major finding

4) Minor findings

5) Impression

6) Classification


Example 12

1) Location

2) Size

3) Major finding

4) Minor findings

5) Impression

6) Classification


Example 13

1) Location

2) Size

3) Major finding

4) Minor findings

5) Impression

6) Classification

* Classification: endoscopic classification of EGC - Paris (2003)


Example 14

1) Location

2) Size

3) Major finding

4) Minor findings

5) Impression

6) Classification

* Desciption example and pathology


Example 15

1) Location

2) Size

3) Major finding

4) Minor findings

5) Impression

6) Classification

* AGC


Example 16

1) Location

2) Size

3) Major finding

4) Minor findings

5) Impression

6) Classification


Example 17

1) Location

2) Size

3) Major finding

4) Minor findings

5) Impression

6) Classification

* Typical response to H. pylori eradication in MALToma


Example 18

1) Location

2) Size

3) Major finding

4) Minor findings

5) Impression

6) Classification

* Retroflection view of the ESD at the greater curvature of the lower body


Example 19

1) Location

2) Size

3) Major finding

4) Minor findings

5) Impression

6) Classification

[More cases]


[Colonoscopy]

Example C-1

Symptom: diarrhea

1) Location: Sigmoid colon

2) Size

3) Major finding

4) Minor findings

5) Impression

6) Classification


Example C-2

1) Location: A colon and T colon

2) Size

3) Major finding

4) Minor findings

5) Impression

6) Classification


Example C-3

1) Location: Sigmoid colon

2) Size

3) Major finding

4) Minor findings

5) Impression

6) Classification


Example C-4

1) Location: mid-T colon

2) Size

3) Major finding

4) Minor findings

5) Impression

6) Classification


Example C-5

1) Location: A colon

2) Size

3) Major finding

4) Minor findings

5) Impression

6) Classification

P


Example C-6

1) Location: mid-T colon

2) Size

3) Major finding

4) Minor findings

5) Impression

6) Classification

Similar case


[Description exercise quiz]

Describe the endoscopy findings follow the SMC style and then send the answer to at stomachlee@gmail.com. Professor Lee will send you the personal feedback.

Description exercise 1

Description exercise 2

Description exercise 3

Description exercise 4

Description exercise 5


5. Case-based discussions on gastric cancer

Case 25 - Finding gastric cancer in the background of erosive gastritis

Case 432 - flat discolorated lesion

Case 17, Case 214 - Blind area

Case 30 - Endoscopic classification of EGC

Case 58, Case 422, Case 448 - Borrmann type IV

Case 685 - GEJ cancer

Case 104, Case 204 - Depth of invasion

Case 43 - False negative biopsy

Case 41 - Changes after biopsy

Case 31, Case 405 - Atypia, atypical glands

Case 38 - Adenoma

Case 315, Case 420 - Remnant cancer

Case 472 - Surgery after ESD for EGC

Case 684 - Anastomosis site recurrence with peritoneal seeding

Case 45 - Gastric metastasis

Case 445 - Rare metastasis of gastric cancer to other organs

Case 101 - Scrub typhus and gastric cancer


6. Case-based discussions on gastric ESD

[Indication: pathology]

Inter-observer variation on pathology

High grade dysplasia (final pathology: EGC)

Atypical gland with HGD

ESD for depressed type adenoma

Papillary adenocarcinoma

Lymph node metastatis at CT

[Indication: gross morphology]

IIa + IIc

Would you recommend ESD or surgery? (EGC IIa+IIc with converging folds.)

Would you recommend ESD or surgery? (small flat depressed lesion with undifferentiated type histology) The patient chose surgery.

Would you recommend ESD or surgery? Ulcer and ulcer findings

Would you recommend ESD or surgery? (unclear margin and undifferentiated type histology)

Would you recommend ESD or surgery? (unclear margin and undifferentiated type histology)

[Patient aspectt]

very very elderly

Would you recommend ESD or surgery for a beyond indication lesion when the patient strongly want a non-surgical treatment?

[Technical aspect]

Twe nearby EGCs. One cut or two cuts?

Instrument. H type knife from Finemedix

ESD for a locally recurrent EGC

ESD for pyloring ring cancer

ESD for cardia cancer in the remnant stomach

Circumferential high grade dysplasia at cardia

[Additional treatment and follow-up]

Additional surgery after ESD

Local recurrence treated by surgery

Metachronous cancer in a followup loss patient

Gastric tube cancer (Deep SM invasion with positive vertical margin)

Esophageal cancer detected in the follow up endoscopy

Colon cancer and lung cancer detected in the follow up examinations.

When do stop follow up CT?

[Cases with learning issues]

left: DLBCL (10 years ago), right: recent screening endoscopy

EGC (fundic gland type)

Pre and post pathological discrepancy


7. Selected lectures on ESD

Surgical and endoscopic treatment of gastric cancer at Samsung Medical Center

2019-4-11. KINGCA


[References]

1) EndoTODAY Endoscopy Learning Center

2) Endoscopy Unit at SMC

3) How I do it - gastric ESD (Professor Jun Haeng Lee)



© EndoTODAY Endoscopy Learning Center. Lee Jun Haeng.