Hi, good morning, everybody. Welcome to the wonderful ASGE JGS ESD hands-on training course here in Chicago. I'm Naofisa Yahagi from Keio University. I'm going to host this wonderful course together with Norio Fukami from Mayo Clinic as course directors of this year. Well, this wonderful ESD training course was originally developed by Professor Kenneth Wong from Mayo Clinic when he was president of the ASGE. Since then, we organized this ESD training course almost every year from 2013. Of course, as everybody knows, ESD was developed in Japan more than 20 years ago. At that time, even in Japan, ESD was regarded as a risky procedure because nobody had experience making circumferential mucosal incision or dissecting submucosal tissue with very bloody situation. Therefore, we were so much criticized by other endoscopy colleagues and also surgeons. That's why we tried to develop original device to make it much safe. Actually, National Cancer Center group developed IT knife and Professor Yamamoto developed the hyaluronic acid to create nice submucosal fluid cushion. I had a chance to develop Flex knife, dual knife, and Dr. Toyonaga developed the brush knife. Everybody developed our original device, and we really care about the safety of the procedure. That's why it became very popular, at least in our country. And gastric ESD was approved by the Japanese government in 2006. Esposir ESD procedure was approved in 2009. And finally, colorectal ESD procedure was approved in 2012. As a result, it becomes really quite procedure in our country. Actually, we usually conduct ESD more than 80,000 cases per year. That means it already becomes standard practice, at least in our country. In every local institution, we have lots of ESD experts everywhere. And we, of course, have lots of very small gastric cancer patients, which is very good for training for the younger generation. We can teach details of ESD side by side in our country and step ahead to the difficult procedures, such as colorectal ESD or duodenal ESD. But unfortunately, here in the United States, you don't have enough case volume for gastric ESD, and you cannot find any teacher who can teach ESD. But I really think that this is a very unique opportunity to run ESD here in Chicago. So I hope you can enjoy this course and you can learn how to conduct the basic technique of ESD. But please try to understand the concept, how to avoid risky procedure at the same time. Thank you very much. And I would like to ask Norio to introduce our wonderful faculties. Norio, please. Thank you, Naohisa. As he explained, this course started in 2013. And every year, we have been training almost 60 for the full capacity. If you think about it, almost close to 600, over 500 people were trained through this course. And over the years, the landscape in the United States has changed. The ESD is much more accepted, and many of you are practicing ESD in the United States. So this is a wonderful opportunity to learn from the Japanese masters. We have Dr. Yahagi will be introducing Japanese faculty, but it's just an honor to work with Japanese faculty. And junior faculty are here, but they're not so junior, actually. They're almost senior level, but we call them juniors, so I'm sorry about that. This year, for the first time, we're doing an advanced course. We felt the need to advance your technique. Once you're in the practice, there's always something that you wanted to improve, and there needs to be some opportunity to learn a little more advanced technique. And we can do more one-on-one teaching. That's what the advanced course is. We structured advanced course to be really hands-on heavy, so only two people in the station. And you get to work with the teacher for many hours. So make sure that you bring your question, and then you get to be answered. You want to learn a specific technique, just ask them, I want to learn this for this advanced course. That's the time that you want to learn all these tricks. For the primary course, we want to prime you to start the ESD. So we're going to go through the basics. And I want everybody to be participating in, ask us questions. This will be a really good interactive session. So having said that, I would like to introduce all this exceptional faculty from the United States. First, Dr. Adam from Northwestern here in Chicago. Dr. Aihara from Brigham and Women's. Dr. Bekara, he came all the way from Canada. He was trained under Dr. Inoue. Dr. Hashimoto, he's a dual trained, just like me, United States and Japan. He went back to Japan and came back to the United States. Now probably he's going to stay for a long time. Dr. Ken Savoy. Everybody knows him with exceptional skills and the sutures is amazing. I learned so many things from him. Now, Dr. Siddiqui is coming from University of Chicago later in the afternoon. She's not here today, at this moment. Dr. Wang, Ken Wang, no introduction needed. He's the president of ASGE and works at Mayo Rochester. So other three are actually for advanced course. They're not going to be here for the first two days. Peter Dragunov, Makoto Nishimura from Sloan Kettering. Peter is at University of Florida and Stavros Stavropoulos. He's at the Oshold Memorial Hospital. He recently changed. Oh, sorry, Amit. Dr. Butt. I didn't mean to forget about you. You're an integral part of the course. Amit is at the Cleveland Clinic. Also no introduction needed. That's our esteemed U.S. faculty. Now, please introduce Japanese faculty. Well, we have wonderful Japanese faculty as well. Yes. Professor Inoue, no need to explain. He is very famous for poem procedure. But unfortunately, this time he has another meeting in Japan. Therefore, he cannot join us in person. But he will give lecture virtually during this course. And Professor Yamamoto is famous for double balloon endoscopy. But at that same time, he is one of the pioneers of ESD. And as I mentioned, he brings the new concept of creating nice subincosal fluid cushion by using hyaluronic acid solution. And he created new technique, which is a pocket creation method. It is really helpful. And Dr. Toyonaga is also a pioneer of ESD. And he developed the flash knife and the crane traction device and many others. And as Norio already mentioned, we have fabulous junior faculty member. They already have probably some of the junior faculty member already have more than 1,000 ESD experience. So, it's not as a really junior. They are kind of expert of ESD. And Mayo Tanabe was coming from Showa University, trained by Dr. Inoue. And Yuto Shimamura also coming from Showa University. He has lots of experience doing poem procedure together with Dr. Inoue. And Seiichiro Abe is coming from National Cancer Center. And he is working together with Dr. Saito, who is famous for colorectal ESD. And Dr. Miura is coming from Jitsi Medical University. He is basically working together with Professor Yamamoto and had many chance to do ESD and double balloon procedure. And Dr. Kikuchi is coming from Toronto Hospital. He was working together with me and he also developed his own device for ESD procedure. And Dr. Sasaki is coming from Kagoshima University. He was also trained by Professor Yamamoto and he is doing lots of ESD procedure in Kyushu now. And Dr. Kato is currently working with me at Keio University. And he published a lot regarding our new technique, which is water pressure method. And it is very effective even for the risky procedure in the duodenum. And Dr. Sakaguchi is coming from Kobe University. He is working together with Professor Toyonaga. And he is a new face, but he already have lots of experience doing ESD. Well, from now, Norio is going to explain what we can do during the course. Thank you. So, several housekeeping items. ASG is committed to the higher education. We take the conflict interest seriously. So, we screen all this presentation for any of the conflict. And if you see any of the bias, please let us know. But all the talks should be free of commercial interest. Now, this course cannot be done without the commercial support. So, special thanks to our vendor supporters. First, the educational grants were provided from Boston Scientific, Irby USA, Fujifilm, Medtronix, Microtech, and Olympus. And thank you so much for your support. Also, the in-kind support that you're going to have all these tools and hands-on labs were supplied by Apollo Endosurgery, Boston Scientific, ComEd, CREA Medical, Irby USA, Fujifilm, Lumendi, Medtronix, Microtech, and Neptune Medical. So, thank you very much for your support. We have on-site exhibitors. If you want to see the products, please visit the exhibitor tables. We have Boston Scientific, Fujifilm, Medtronix, Microtech, Irby, CREA Medical, and Lumendi. So, very interesting products are listed on the table. Don't miss the opportunity at the lunchtime morning. They are there to showcase their products. One of the requests we have is to raise your own awareness related to diversity, equity, and inclusion. So, we encourage you to use your voice to advance the endoscopic profession, regardless of the race, color, gender, identity, religion, national origin, ancestry, citizenship, geographic location, physical ability, age, veteran status, or sexual orientation. That's our request. Now, coming to the hands-on. This year, we've formatted as we're going to sit, everybody sit in the auditorium for the morning. So, this is going to be a lecture session for the morning. Once you have lunch, half of the group go to the hands-on, half stays here. And after two hours, we're going to switch. And don't worry, you're going to have lots of hands-on time. It's only two hours for the first day. Tomorrow is going to be full day hands-on. So, don't get too anxious about it. Look at your badge. You have either red or blue. Red group goes to the hands-on first. And I encourage everybody to change into scrub during the lunchtime, even before or after having lunch, to be prepared for the hands-on. It's going to be really hectic and going back and forth. There will be a person to guide you when to change, where to go. So, just listen to the announcement. First day is going to be hectic. Tomorrow is much better. So, just follow the lead from the ASG staff. The hands-on session, many of you have been here already, but the hands-on lab is called Bioskills Lab. It's through the bathroom. Once you go to the bathroom, there's an additional door. If you open that, it's going to be locker room. So, you can have the scrub, change into it, use the locker. You can just store stuff and go through additional door. Then it's going to be lab. Then ASG staff will guide you where to go. Food and drinks are not allowed in the lab, so just leave it in the locker room or just finish drinking, eating, and then go into the lab. And, again, please change into scrub as early as possible. This morning is introduction. Starting tomorrow, when you come in, just change into scrub so that you're going to be ready for hands-on. We want to use this time really efficiently. We have a virtual audience. Thanks for participating to the virtual audience, and we want to encourage you to participate as well. You can ask questions through the question board or chat box. The question board is preferred. And for these attendees, when you want to ask questions, raise your hand, put your hand up, and if you have a question, raise your hand. For these attendees, when you want to ask questions, raise your hand, and when you speak up, you have to push the button first. You can see there's the button part. Once you push the button, the light comes on. If the light is on, your mic is active. Okay? So then you can start speaking so that everybody can hear. The questions are welcome and encouraged. Lastly, we would like to have the evaluation and feedback. Please complete the online evaluation and just give us a feedback, me, Dr. Yahagi. Let us know what we can improve for the future courses. Next year, we'll do, again, primary and advanced, hopefully an improved version. So thank you very much for your participation, and it's going to be exciting two days or four days if you decide to be for four days. Thank you. applause

ASGE JGS ESD hands-on training course

Chicago

Endoscopic Submucosal Dissection

ESD

safety during the procedure