Course in advanced therapeutic endoscopy

The techniques taught

Therapeutic endoscopy covers procedures that treat lesions through the endoscope, without external incision and with the organ preserved. Training is practical, because the objective is handling and complication management in real time.

Core procedures

• Submucosal dissection (ESD), removing extensive or flat lesions in a single piece
• ERCP with cholangioscopy, for stones and biliary strictures
• Endoscopic ultrasound, for staging and targeted biopsy
• Gastrostomy and jejunostomy, establishing feeding access without surgery

Why expertise matters

These procedures are technically demanding and outcome depends on experience. The difference between a complete resection and one that leaves residual tissue is not visible at the time of the procedure: it appears in the pathology report and, later, in the rate of local recurrence.

How the result is judged

Success is not measured by completing the procedure but by the pathology report. The pathologist assesses whether the resection margins are clear and how deep the invasion extends. Those two findings determine whether removal was oncologically adequate or whether further treatment is needed, and they set the surveillance interval. This is why en bloc removal matters so much: without it, the judgement on margins becomes uncertain.

Managing complications

Complication management is part of the training, because it is what separates an experienced endoscopist from a competent one. The main complications are bleeding and perforation, and in the great majority they are dealt with endoscopically in the same session, using clips or other closure techniques. The ability to recognise and close a perforation on the spot is what makes demanding resections safe to attempt.