WISE - A Portuguese doctor’s experience of the WISE onsite hands-on training 2022

The WEO International School of EUS (WISE) is a highly sought-after unique training program focusing on endoscopic ultrasound. Find out more about the program from this account by Dr. Mariana Machado who recently attended the onsite hands-on training course as one of the winners of the WISE 2022 cohort.

I am a Portuguese gastroenterologist with a special interest in endoscopic ultrasonography (EUS). I had the privilege to be selected for the 2022 WEO International School of EUS (WISE) and to attend the hands-on course in January 2024.

The WISE program started in 2018, founded by Professor Dong Wan Seo of the Asan Medical Center in Seoul, Korea. The attendees already have some experience of and are currently performing EUS, and the training programis designed to continuously expose them to seminars, with active participation including presentation of clinical cases, and afterward to a hands-on training. Thus the program has a true impact on mastery of EUS that would not be possible with a one-time course.

The hands-on training took place at the Asan Medical Center, Seoul, from 13 to 19 January 2024.

In the first weekend, attendees presented reviews and clinical cases that they found challenging. These were then discussed by a faculty of eminent experts in the field, from Korea, Taiwan, and Japan, including Prof. Dong Wan Seo himself, but also Profs. Jong Yun Lee, Tae Jun Song, Jian-Hwa Chen, Tae Hyeon Kim, and Takeshi Ogura. It was an incredible opportunity to hear their advice and tips on how to solve those clinical problems, and one where they answered our doubts and concerns in a generous and friendly environment. We also had a first contact with a pig animal model, in order to appreciate the anatomic differences from humans and to perform some diagnostic and therapeutic procedures in animal and in vitro models.

During the following week, we had the opportunity to follow the clinical activity of Prof. Seo and his team, including Profs. Tae Jun Song, Dong Wook Oh, and Gunn Huh, and Dr. Hoseung Lee, in a world-leading gastroenterology department. We attended ward rounds in which all admitted patients were discussed, and afterwards we watched all the EUS and ERCP procedures performed, including advanced interventions. This was an amazing experience, as we observed cutting-edge, complex, and advanced biliopancreatic interventional procedures done by leading experts in the field. Prof. Seo and his team welcomed us wholeheartedly, generously discussed the clinical cases, and shared tips to improve our diagnostic and therapeutic skills. Also, because we were integrated into the clinical activity, we could observe in loco how the endoscopic unit is structured, how the team is organized, how the endoscopic process including the pre- and post- procedure is delineated, and what equipment is used, in order to optimize the efficacy and the results of the unit. This experience had a huge impact in me and will certainly result in effective changes in the endoscopy process in my unit.

The hands-on component was performed in pig animal models with bile duct obstruction and pancreatic pseudocysts, developed by Prof. Seo and Dr. Lee themselves, as well as in ex vivo and in vitro models for radiofrequency ablation. Before the hands-on training, senior doctors gave technical reviews on the different EUS interventional procedures, which were then applied in the animal model under the supervision of Prof. Seo and his team. This hands-on course has no parallel amongst other EUS training courses, and allowed us to improve our technique in an in vivo model that is very similar to humans. For me personally, with limited experience in intervention, this demystified interventional EUS and gave me the tools and inspiration to pursue therapeutic EUS.

My learning process was greatly supported by the colleagues on the course, who also generously shared their knowledge and skills and who are now my dearest friends.

Lastly, Prof. Seo was truly inspirational, being not only a master in biliopancreatic endoscopy, but also a remarkable clinician. With his holistic view of the patient, he thoroughly evaluated the patient’s history, not only the presenting clinical problem, and drew lessons with each patient. He also showed us that not all patients fit into the same box, and that medicine must be personalized.

Prof. Seo and the WISE course also inspired me to pursue excellence and to push myself to continuously perfect my skills – our limits are decided by ourselves.

In a final word, I want to express my most profound gratitude to Prof. Seo and to all his amazing team, with a special note to Dr. Lee who tirelessly ensured that we got the most out of the hands-on experience, to Laura Schleser-Low who took great care of us and accompanied us throughout the journey, and Sohee Lee who looked after the logistics. The opportunity and honor of participating in WISE 2022 and in the hands-on training is an experience that will truly impact my EUS journey and that I will forever cherish.

Mariana Verdelho Machado