Training model for teaching endoscopic submucosal dissection of gastric tumors.
BACKGROUND
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%.


METHODS
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.
Vázquez-Sequeiros
E
E
Service of Gastroenterology, University Hospital Ramón y Cajal, Madrid, Spain. evazquez@hotmail.com
de Miquel
D Boixeda
DB
Olcina
J R Foruny
JR
Martín
J A González
JA
García
M
M
Lucas
D Juzgado
DJ
Garrido
E
E
González
C
C
Blanco
A Parra
AP
Arnau
M R
MR
Buenadicha
A
A
Vicente
V Moreira
VM
de Argila
C Martín
CM
Milicua
J M
JM
D000818:Animals; D004210:Dissection / Q000193:education* / Q000379:methods*; D004724:Endoscopy / Q000193:education* / Q000379:methods*; D016145:Endoscopy, Digestive System; D023421:Models, Animal; D011446:Prospective Studies; D013274:Stomach Neoplasms / Q000601:surgery*; D013552:Swine