Experimental gastric endoscopic submucosal dissection: training in a porcine model
(EN)
Georgopoulos, Sotirios
Delis, Konstantinos
Christodoulou, Dimitrios
Kasapidis, Panagiotis
Triantafillidis, John
Paraskeva, Konstantina
Tribonias, Georgios
Komeda, Yoriaki
Mavrogenis, Georgios
Papalois, Apostolos
Kashida, Hiroshi
Panteris, Vassilios
Tsiamoulos, Zacharias
Fukuhara, Takataro
Bassioukas, Stefanos
Emmanouil, Theodoros
Background Endoscopic submucosal dissection (ESD) requires special skills and a long procedure time for a quality-controlled procedure. A universal training system remains to be established. Hands-on courses in animal models before advancing to the human colon appear to be essential, especially in Europe. The learning curve is a prerequisite in ESD, in order to improve technical outcomes and decrease the rate of procedural adverse events.Methods In the experimental research center of ELPEN Pharmaceuticals, 18 European endoscopists, inexperienced at ESD, performed gastric ESDs in porcine models. The course lasted two days and was conducted under the supervision of experts.Results A total of 72 of 76 ESDs were completed en bloc (94.7%). The procedural time and cutting speed differed significantly between the first and second day: 48±4.4 vs. 43±4.8 min (P=0.0045), and 1.38±0.20 vs. 1.63±0.23 cm2/min (P=0.0033), respectively. The complications were not significantly different between the two groups: five (13.88%) vs. four (11%) episodes of bleeding (P>0.05). The perforation rate was similar, at two episodes per day (5.55%). We documented an acceptable rate of en bloc resections and complications.Conclusion ESD demands a new level of endoscopic skills in Europe. A formal sequential training program, using porcine models, may benefit countries with a low volume of cases.Keywords Endoscopic submucosal dissection, animal models, ESD training, hands-on course, procedural timeAnn Gastroenterol 2017; 30 (4): 446-449
(EN)
