Reply to Mannath & Ragunath

We thank Drs. Mannath and Ragunath for their thoughful comments on our study. They propose a one-to-one training program in endoscopic resection according to the traditional fellow-in-training approach, resulting in a gradual process towards independent practice. Although we agree that such an interaction enables gradual and prolonged training we thought that this would be less applicable in our country for teaching endoscopic management of early neoplasia in the upper gastrointestinal tract. We considered this to be a postgraduate training for which a certain level of endoscopic experience would be required. In addition, we wanted to train a limited number of centers, preferably geographically spread across the Netherlands. Finally, we wanted to ensure that centralized treatment would be available within a relatively short period of time (2 years). The traditional approach suggested by Mannath & Ragunath would not have enabled us to facilitate centralization to selected centers at this scale and time frame. In addition, the fellow-in-training approach does not ensure centralization of diagnosis and treatment, since the fellow trained may not necessarily be appointed in centers that are suitable for a referral function in this field and building such a referral function requires more than just the presence of a trained endoscopist.