Thank you very much for your kind introduction. 
AI is becoming quite popular in endoscopy units. AI diagnosis systems are actively tested in endoscopy centers. Personally, I am using AI for endoscopy description exercise. However, AI ESD training system is not available yet. So, today¡¯s talk is quite traditional one. 
At Samsung Medical Center, we are developing ENAD system with AINEX company.
It is an AI-based real-time lesion detection system and it also suggests the endoscopic diagnosis such as AGC, EGC, adenoma and benign lesions.
This is an AGC just below the cardia. You can see the AI diagnosis in the down left corner. The next case is an AGC of the gastric angle. The final case is EGC at the greater curvature of the gastric antrum. I don¡¯t have enough time to talk about AI diagnosis of gastric cancer. So, I will move on to the next topic of ESD.
For more than 25 years, I have been running a non-profit educational internet site named endotoday.com. The main topic is endoscopy learning. 
I asked to Claude how to learn gastric ESD based on endotoday.com. Claude answered my site teaches ESD as a stepwise fashion such as scope handling, EndoGEL ESD, ex vivo pig stomach ESD, live pig ESD and finally clinical cases.
Using the gastroscopy BOXIM, you can learn essential basic skills of endoscopy handling. EngoGEL is the beginning of real ESD learning and the realist training can be done with ex vivo and live pig ESD.
Technically, one of the most important tip is ¡°if difficult, get closer!¡±
Claude also got the important ideas like ¡°Never ESD alone at first.¡±
I asked the similar question to Gemini, and she answered like this. Intensive observation is important. 
Stepwise hands-on simulator training is necessary.
Give and take method.
Get review and commentary from experienced masters. Very good. My impression is that Gemini is better than Claude for this purpose. Anyway¡¦
Do you think you can learn ESD skills with AI? Maybe not. You cannot learn the ESD skills with well-organized AI summary. 
When I learned the ESD in the year 2004, there was no textbook on ESD and every information was almost top secret. I wrote down all the information from different hospitals from Japan like this and shared it on my webpage. 
At that time, my hero was ¹®ÀÍÁ¡, a famous thief. 
Recently, we have a lot of textbooks, seminars, symposiums about ESD. So, just knock the door. You can get it. 
Before further discussion about how to learn ESD, I¡¯d like to show you some of the recent experience in my institution. Two young endoscopists recently started their independent ESD procedures. 
I got a letter from a young endoscopist about her first independent ESD procedure. The pathology was SM2 cancer without lymphovascular invasion. The patients is 75 years old man with some risk factors. So, she¡¯s will discuss with the patient and their family members about the risk and benefit of the additional surgery.
This is the endoscopy before the procedure. Histologically, tubular adenocarcinoma, moderately differentiated. 
When I reviewed the patient¡¯s record, she already explained in detail about the risk of SM invasion before the endoscopic treatment. 
The procedure was excellent. Can you believe it? This is her first real patient ESD. I can say it was really fantastic. 
SM 2 cancer without lymphovascular invasion.
This is the pathology.
You can see the submucosal invasion. But the deep resection margin was not involved. 
Another letter from young endoscopist about his second ESD experience. He said that ¡°thanks to having plenty of opportunities to practice step-by-step since last year?ranging from endoGEL and ex-vivo to live pigs?I was able to proceed calmly with confidence in my knife handling during the actual procedure.¡± 
This is the endoscopy before the procedure. Histologically, tubular adenoma, high-grade dysplasia vs. tubular adenocarcinoma, well differentiated. 
He explained very carefully in SMC style. Actually, my style. 
He beautifully used the standard ESD techniques with IT-2 knife. 
12 mm sized moderately differentiated tubular adenocarcinoma limited in the lamina propria. Curative resection.
How can they performed their initial independent ESDs so beautifully? I think our systemic training program should have helped their soft landing to the ESD field. 
You can see the fellowship training program at my internet site endotoday.com.
We started with EndoGEL ESD hands-on training, and then ex vivo pig stomach ESD and live pig ESD sessions.
This year¡¯s final ESD training has just finished a few days ago. I¡¯d like to thank you very much to SMC clinical simulation center and Olympus K-TEC for their great support. 
ESD training should be stepwise. It starts with basic training with an ESD training bag. Next step is EndoGEL ESD, Ex-vivo pig stomach ESD, live pig ESD and finally the real clinical case ESD. 
Movement of ESD knife is mostly circular and horizontal. For the training of knife control in the circular and horizontal direction, I developed an ESD training bags.
Like this.
In the training endoscopy, it looks like this. You can follow the line as a training. 
Second step is ESD using the artificial layer EndoGEL.
EndoGEL is a good alternative of ex-vivo pig stomach. It was originally released in a paper box. 
But we are using the EndoGEL with Koken gastroscopy simulator because it is more realistic. 
We teach two procedures. The procedure 1 is pin-knife method using Dual knife, Flush knife or M knife. The second procedure is IT-2 based method. 
Video
We are organizing a lot of EndoGEL ESD hands-on training sessions in various occasions. This is the 3rd therapeutic GI endoscopy and ESD training in Daegu. 
EndoGEL ESD hands-on training can be done at any place even at a conference booth. I love this kind of live demonstrations. 
Recent EndoGEl ESD hands-on training at SMC clinical simulation center. 
ESD simulators made in Korea by professor ÀÌÁøÇõ is also available. 
This is the step three, ex vivo pig stomach ESD. 
Step 4 is live pig ESD in the animal surgery room, Song-do Olympus center.
I have visited Taichung for live pig ESD last year.
Live pig ESD hands-on training is a lot of fun. 
Step 5 is the real patient ESD. In this step, there are trainer steps and trainee steps. 
Before starting ESD for the first time, beginners should have some experience as the first assistant. With some cases, the main operator usually give the beginners to do part of the ESD steps. 
After the first ESD, I took pictures for memory. 
Tele-mentoring using iPhone Facetime app is a very useful tool for ESD beginners. International mentoring is also possible. If you want some real-time comments from me, please send me an e-mail (stomachlee@gmail.com).
E-mail consultation is always available. Please send me an e-mail, when you have any questions about any issues regarding the ESD for EGC. 
For the foreign doctors, one-week ESD training course is also available at my institution. It consists of introductory lectures, ESD observation, ESD conference and ESD planning session, hands-on training with EndoGEL. 
Sometime foreign doctors visit SMC for EndoGEL ESD training.
Korean Society of GI Endoscopy organizes a lot of diagnostic and therapeutic endoscopy workshops. Why don¡¯t you apply for them. 
I strongly recommend to see the video clips, which are available at KSGE webpages. 
Ladies and gentlemen. I¡¯d like to wrap up my talk by saying that steps for ESD skill development are well established. So, my young friends, just knock the door. Thank you.