A fellowship abroad is often the only route to advanced endoscopy training from sub-Saharan Africa. This lecture sets out what can be done before the trainee arrives, how to structure the fellowship around feedback rather than volume, and what support the trainee needs back home.
Self-contained argument with a concrete number: self-taught ESD takes around 250 cases, structured training 30 to 40, and the gap is feedback rather than volume. It needs no prior context and states the thesis of the talk.
Advanced endoscopy training in sub-Saharan Africa usually means going abroad. The slots are few, most fellowships are self-funded, and the trainee often leaves a family and a post behind for months at a time.
So the question is not only how to find a fellowship. It is how to make six months count.
This lecture from the South Africa 2026 postgraduate course takes the trainer's side of that problem. It was given in a joint session with Vikash Lala, who completed a six-month advanced endoscopy fellowship in Ghent after a two-and-a-half-year COVID delay.
"It was not necessarily a problem of volume, but a problem of feedback, structured feedback."
Vikash used the delay. He watched hundreds of EMR, ESD and third-space cases on virtual platforms before he arrived. By the time he was in the room, he knew what the next instruction would be before it was given.
Much of the background can be moved out of the room:
Supervised time is then spent on the movement itself and on responding to what is actually happening. That needs a unit and a trainer who treat training as an investment of time.
"It's not necessarily the technical act that's that difficult. Decision-making is critical."
Self-taught ESD carries a learning curve of around 250 cases. Structured, supervised training brings that closer to 30 to 40.
Japan has the case volume, the experts and protected curriculum time. But the gap for Western trainees was not only volume. It was access to someone who would critique the case.
"It was not necessarily a problem of volume, but a problem of feedback, structured feedback."
"If you do not, especially when you get a complication, look back at what went wrong and figure out why ... you will not learn."
Case selection follows a risk pyramid: gastric and rectal lesions first, then colon, oesophagus and duodenum.
"Everything you can do outside of an endoscopy room should be done outside of an endoscopy room."
The trainee goes from a high-volume centre to a low-volume one. The practical advice is simple: do not start with a circumferential ESD in the first weeks home. Continued case review, including by video from a distance, extends the fellowship beyond the time spent abroad.
The evidence base is thin. There are no randomised trials of ESD training methods, and most of what we know comes from Eastern settings. The lecture closes with preliminary, unpublished data from repeated tip-control practice on a simulator, in which performance continued to rise across the first eight sittings.
"If we stop chasing case volume and start engineering how we feedback to trainees, I think we can do better."
Trainers who host international fellows, trainees planning an advanced endoscopy fellowship, and those building training pathways in units where complex cases are infrequent.
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