Impact of Cadaver Porcine Model Hands-On Training (CPM-HOT) for endoscopic submucosal dissection (ESD) and per-oral endoscopic myotomy (POEM) – does it help training of physicians for these advanced procedures? Results of a post-training questionnaire

Aims Expertise in advanced endoscopy procedures – ESD ' POEM (collectively – third space endoscopy [TSE]) is largely limited to select centers. There is global need for trained physicians competent to perform TSE. Optimum TSE training has been difficult due to limited opportunities ' ethical issues regarding training on live patients. Cadaver Porcine Model Hands-On Training (CPM-HOT) has emerged as a popular training platform. This study aims at evaluating impact of CPM-HOT on TSE training using an online questionnaire.

Methods We conducted 12 CPM-HOT using in-house developed special fresh CPMs during 2014 – 2024. Participants – endoscopists>5-years’ experience in advanced endoscopy (ERCP). Online questionnaire was circulated to all participants to evaluate impact of CPM-HOT on current TSE practices, perceived benefits ' limitations of CPM-HOT.

Results 280 participants attended CPM-HOT workshops. 188/280 (67.1%) responders. 57.4% respondents aged 36-45 yrs; males (96.8%). Prior endoscopy training ' practice – advanced procedures – 91.5%,>10/week – 31.4%; institutional practice – 64.4%. No prior TSE experience – 69.7%. 30.3% perform TSE – POEM – 84.2%, ESD – 78.9%; independent operators – 71%. Reason to attend CPM-HOT – TSE first exposure (27.7%), need for additional hands-on ' improve orientation (26.6%), enhanced hands-on exposure to begin TSE (22.3%). CPM-HOT undertaken by 93.1% (n=175) respondents. 145/188 (77.1%) respondents initiated/improved TSE after attending CPM-HOT. Additional training – observation at high-volume center – 31%, additional CPM-HOT – 23.2%, in-person proctorship – 19.7%, hands-on training on patients – 17.6%. 1^st TSE procedure –POEM (60%), ESD (40%). 66.9% confirmed ability to perform TSE independently. 51% advanced to other TSE, 75.9% perform 3 procedures monthly. 96.6% respondents felt that CPM-HOT was useful to address technical challenges. Key takeaways – improved tissue plane orientation (64.6%), overcome TSE inhibitions (44.2%), improved cognitive hand skills (41.4%). 141 (75%) respondents reported reasonable confidence (> 60%) to perform TSE. 43 (22.9%) respondents have not begun TSE despite attending CPM-HOT. Main reasons – require further training (76.7%), require additional hands-on (62.8%). 64.9% preferred HOT on live models ' in-person proctorship (64.4%) for future training.

Conclusions CPM-HOT workshops are important tools to train endoscopists in TSE, improving tissue plane orientation ' cognitive hand skills, although additional training is often concurrently necessary. 3/4^th respondents could begin/improve TSE post CPM-HOT. Beyond CPM-HOT, trainees have strong preference for HOT using live models ' for in-person proctorships.

 

MissingLinkText

Conflicts of Interest

Authors do not have any conflict of interest to disclose.

Publication History

Article published online:
27 March 2025