Training model for teaching endoscopic submucosal dissection of gastric tumors

Training model for teaching endoscopic submucosal dissection of gastric tumors

Introduction: the elevated risk of complications and technical complexity of endoscopic submucosal dissection (ESD) has limited its implementation in our medical system. Objective: to design and evaluate a training program for learning the ESD technique. Methods: four endoscopists with no experience with ESD underwent a 4-step training program: 1) review of the existing literature, didactic material, and theoretical aspects of ESD; 2) ESD training in an ex-vivo animal model; 3) ESD training in an in-vivo animal model(supervised by ESD expert); and 4) ESD performance in a patient. A standard gastroscope and an ESD knife (IT, Flex or Hook-knife Olympus®) were employed. The classical ESD technique was performed: rising of the lesion, circumferential incision, and submucosal dissection. Results: ex-vivo animal model: 6 x swine stomach/esophagus -cost < 100 euro; 6 x ESD: antrum (n = 2), body (n = 3) and fundus/cardia (n = 1)-; size of resected specimen: 4-10 cm; ESD duration: 105-240 minutes; therapeutic success: 100%; complications: perforation (1/6: 16%) sealed with clips. In-vivo animal model: 6 ESD (antrum/body of stomach: 4; esophagus: 2); size: 2-5 cm; duration: 40-165 minutes; success: 100%; complications: 0%. Patient: ESD of a gastric lesion located in the antrum/body; size: 3 cm; duration 210 minutes; a complete resection was achieved; no complications. Conclusions: the results of the present study support the usefulness of this model for learning ESD in our system.

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Bibliographic Details
Main Authors: Vázquez-Sequeiros,E., Boixeda de Miquel,D., Foruny Olcina,J. R., González Martín,J. A., García,M., Juzgado Lucas,D., Garrido,E., González,C., Parra Blanco,A., Arnaa,M. R., Buenadicha,A., Moreira Vicente,V., Martín de Argila,C., Milicua,J. M.
Format: Digital revista
Language:English
Published: Sociedad Española de Patología Digestiva 2009
Online Access:http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-01082009000800005
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Summary:Introduction: the elevated risk of complications and technical complexity of endoscopic submucosal dissection (ESD) has limited its implementation in our medical system. Objective: to design and evaluate a training program for learning the ESD technique. Methods: four endoscopists with no experience with ESD underwent a 4-step training program: 1) review of the existing literature, didactic material, and theoretical aspects of ESD; 2) ESD training in an ex-vivo animal model; 3) ESD training in an in-vivo animal model(supervised by ESD expert); and 4) ESD performance in a patient. A standard gastroscope and an ESD knife (IT, Flex or Hook-knife Olympus®) were employed. The classical ESD technique was performed: rising of the lesion, circumferential incision, and submucosal dissection. Results: ex-vivo animal model: 6 x swine stomach/esophagus -cost < 100 euro; 6 x ESD: antrum (n = 2), body (n = 3) and fundus/cardia (n = 1)-; size of resected specimen: 4-10 cm; ESD duration: 105-240 minutes; therapeutic success: 100%; complications: perforation (1/6: 16%) sealed with clips. In-vivo animal model: 6 ESD (antrum/body of stomach: 4; esophagus: 2); size: 2-5 cm; duration: 40-165 minutes; success: 100%; complications: 0%. Patient: ESD of a gastric lesion located in the antrum/body; size: 3 cm; duration 210 minutes; a complete resection was achieved; no complications. Conclusions: the results of the present study support the usefulness of this model for learning ESD in our system.

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