EFFICACY OF A THREE-DAY TRAINING COURSE IN ESD USING A LIVE PORCINE MODEL: A PROSPECTIVE EVALUATION

Aims:

Endoscopic submucosal dissection (ESD) is the method of choice for “en-bloc” resection of superficial tumors. European countries are late in implementing this method, and current guidelines recommend training on animal models. The objective of our study was to prospectively evaluate the efficiency of an ESD training course using live anaesthetized pigs.

Methods:

Fourteen endoscopists, novices in ESD, participated in three gastric ESD training courses on anaesthetized pigs. Each trainee resected five “fake” lesions, delimited beforehand in the antrum of the antro-fundic junction. At the end of each session, pigs were sacrificed and stomachs removed for histological examination, to look for perforation. Resected specimen sizes, ESD speeds, and complication rates were evaluated prospectively.

Results:

Seventy procedures were performed, among which 58 could be analyzed. All the resections were “en-bloc”. There was a significant increase in ESD speed (from 10.1 mm²/min to 34.2 mm²/min, p = 0.016) during the sessions. This increase was marked between the first two ESD compared with the fourth and fifth. There was a significant relation between surface area of the resected lesion and procedure speed (p < 0.0001). The complication rate was 8.6%, with a nonsignificant trend for an increase between the two first ESD and the subsequent three (p = 0.058).

Conclusions:

There is a clear benefit from ESD training courses on animal models. Improved endoscopist capability is evident from the third ESD. These data validate the indispensable nature of dedicated training courses and echo the current guidelines on the necessity for multistep ESD learning, beginning on animal models.