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Endoscopy 2013; 45(06): 451-457
DOI: 10.1055/s-0032-1326483
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Validation of a live animal model for training in endoscopic hemostasis of upper gastrointestinal bleeding ulcers[1]

M. Camus
1   Gastroenterology and School of Surgery, Lariboisière Hospital, APHP, Paris 7 University, Paris, France
2   Inserm Unit 965, Paris, France
,
P. Marteau
1   Gastroenterology and School of Surgery, Lariboisière Hospital, APHP, Paris 7 University, Paris, France
3   Inserm CRB3, Innovation et Recherche en Endoscopie et en Chirurgie (ITEC), Paris, France
,
M. Pocard
2   Inserm Unit 965, Paris, France
4   Department of Surgery, Lariboisière Hospital, APHP, Paris 7 University, Paris, France
,
C. Bal dit Sollier
5   Laboratory of Hematology Hemostasis and Thrombosis Lariboisière Hospital, APHP, Paris 7 University and Institut des Vaisseaux et du Sang, Paris, France
,
A. Lavergne-Slove
6   Department of Pathology, Lariboisière Hospital, APHP, Paris 7 University, Paris, France
,
A. Thibault
1   Gastroenterology and School of Surgery, Lariboisière Hospital, APHP, Paris 7 University, Paris, France
5   Laboratory of Hematology Hemostasis and Thrombosis Lariboisière Hospital, APHP, Paris 7 University and Institut des Vaisseaux et du Sang, Paris, France
,
S. Lecleire
7   Department of Hepatology and Gastroenterology Rouen University Hospital, Rouen, France
,
A. Vienne
8   Department of Gastroenterology, Cochin Hospital, APHP, Paris 5 University, Paris, France
,
B. Coffin
9   Department of Gastroenterology, Louis Mourier Hospital, APHP, Paris 7 University, Paris, France
,
L. Drouet
5   Laboratory of Hematology Hemostasis and Thrombosis Lariboisière Hospital, APHP, Paris 7 University and Institut des Vaisseaux et du Sang, Paris, France
,
X. Dray
1   Gastroenterology and School of Surgery, Lariboisière Hospital, APHP, Paris 7 University, Paris, France
2   Inserm Unit 965, Paris, France
3   Inserm CRB3, Innovation et Recherche en Endoscopie et en Chirurgie (ITEC), Paris, France
10   Division of Gastroenterology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
› Author Affiliations
Further Information

Publication History

submitted 02 August 2012

accepted after revision 22 January 2013

Publication Date:
03 June 2013 (online)

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Commentaire de travail de Camus M et al., pp. 451Endoscopy 2013; 45(06): 593-593
DOI: 10.1055/s-0033-1344367

Background and study aims: The management of upper gastrointestinal bleeding requires training of the endoscopist. We aimed to validate a live animal model of bleeding ulcers for training in endoscopic hemostasis.

Materials and methods: Bleeding ulcers were created by repeated grasp-and-snare gastric mucosectomies in pigs rendered “bleeders” by preadministration of clopidogrel, aspirin, and unfractionated heparin. The feasibility and reproducibility of the model (proportion of bleeding ulcers, number of ulcers per animal, and time needed to produce a bleeding ulcer) were prospectively evaluated in six animals. Ten endoscopic experts assessed the similarity of this pig model to human bleeding ulcers (four-point Likert scale). The training capabilities of the model for hemostatic techniques (needle injection, bipolar electrocoagulation, and hemoclipping) were evaluated in 46 fellows (four-point Likert scale).

Results: A total of 53 gastric ulcers were created in 6 animals (8.8 ± 1.5 ulcers/animal). Successful active ulcer bleeding (Forrest Ib) was achieved in 96.2 % of cases. Bleeding was moderate to abundant in 79 % of cases. Ulcerations consistently reached the submucosal layer. The mean (± SD) time taken to create a bleeding ulcer was 3.8 ± 0.6 minutes. Endoscopic experts assessed the realism of the ulcers and bleeding at 3.2 ± 0.7 and 3.6 ± 0.7 respectively on a four-point Likert scale. The training significantly improved the endoscopic skills of the 46 fellows (P < 0.0001) in all hemostatic techniques.

Conclusions: The live porcine model of bleeding ulcers was demonstrated to be realistic, reproducible, feasible, time efficient, and easy to perform. It was favorably assessed as an excellent model for training in endoscopic treatment of bleeding ulcers.

1 Note: This study was presented during a free paper session at the United European Gastroenterology Week, London, UK, 21 – 25 November 2010.


 

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