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ESGE Issues Comprehensive Training Curriculum on Optical Diagnosis

Douglas K. Rex, MD, MASGE, reviewing Dekker E, et al. Endoscopy 2020 Sep 3.

The extent to which optical diagnosis is used in routine endoscopy in the United States to improve treatment decisions in endoscopy is virtually unknown. 

The European Society of Gastrointestinal Endoscopy has now issued a curriculum that covers optical diagnosis training in Barrett’s esophagus, squamous cell cancer of the esophagus, early gastric cancer, diminutive colorectal lesions, early colorectal cancer, and inflammatory bowel disease.

The general recommendations are, first, that every endoscopist should have competence in upper and/or lower endoscopy before training in optical diagnosis. Competency can be learned by attending a validated optical diagnosis course, followed by self-learning on a specified minimum number of lesions. If no validated course is available, then training requires attending a nonvalidated, onsite training course, followed by self-learning with a specified minimum number of lesions. Trainees should then achieve competence thresholds by assessing a minimum number of lesions prospectively during real-time endoscopy, and finally, in vivo practice to maintain competence. 

The document lists specific training programs for each clinical area, when available, and recommends the number of lesions to be assessed in vivo in real time to measure and establish initial competence. The recommendations also include a second number of ongoing lesions to be assessed per year to maintain competence.

Douglas K. Rex, MD, FASGE


Much of the optical diagnosis discussion in the U.S. has centered on the resect-and-discard policy for diminutive colorectal lesions, which although proven effective and cost-effective, has been delayed by institutional policies, perceived medical-legal risk, and lack of financial incentive. However, optical diagnosis has many uses in endoscopy that can guide decisions, such as piecemeal resection versus en bloc resection versus surgery. Formal recommendations around training and competency in this skill are an important aspect of improving endoscopy quality and outcomes.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.


Dekker E, Houwen BBSL, Puig I, et al. Curriculum for optical diagnosis training in Europe: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy 2020 Sep 3. (Epub ahead of print) (

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