Training model for teaching endoscopic submucosal dissection of gastric tumors

ABSTRACT

Introduction: the elevated risk of complications and technicalcomplexity of endoscopic submucosal dissection (ESD) has limitedits implementation in our medical system.Objective: to design and evaluate a training program forlearning the ESD technique.Methods: four endoscopists with no experience with ESD underwenta 4-step training program 1) review of the existing literature,didactic material, and theoretical aspects of ESD; 2) ESDtraining in an ex-vivo animal model; 3) ESD training in an in-vivoanimal model (supervised by ESD expert); and 4) ESD performancein a patient. A standard gastroscope and an ESD knife (IT,Flex or Hook-knife Olympus®) were employed. The classical ESDtechnique 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) andfundus/cardia (n = 1)–; size of resected specimen 4-10 cm; ESDduration 105-240 minutes; therapeutic success 100%; complicationsperforation (1/6 16%) sealed with clips. In-vivo animalmodel 6 ESD (antrum/body of stomach 4; esophagus 2); size2-5 cm; duration 40-165 minutes; success 100%; complications0%. Patient ESD of a gastric lesion located in theantrum/body; size 3 cm; duration 210 minutes; a complete resectionwas achieved; no complications.Conclusions: the results of the present study support the usefulnessof this model for learning ESD in our system(AU)