Endoscopic submucosal dissection training with pig models in a Western country.
OBJECTIVE
To test a strategy for endoscopic submucosal dissection (ESD) training in animal models designed to overcome the initial learning curve.


METHODS
ESD was attempted in ex vivo and in vivo pig models. Thirty ESD procedures were attempted in the esophagus (n = 9) or the stomach (n = 21). The ex vivo model was used until initial competence was achieved. In the in vivo model, several ESD procedures were performed in up to 3 sessions. The following variables were analyzed: specimen size, complete and en bloc resection rate, time for circumferential incision, time for submucosal dissection, total ESD duration, and complications.


RESULTS
Complete resection was achieved in 28 cases (en bloc 27); 2 could not be completed (one perforation, one technical difficulty). The mean +/- SD time for circumferential incision was 36.2 +/- 16.8 min (range: 8-87 min), and the mean +/- SD time for submucosal dissection was 45.1 +/- 35.7 min (range: 9-196 min). The mean +/- SD size of the resected specimens was 45.2 +/- 17.8 mm. The mean +/- SD total resection time was significantly increased for the gastric cases performed in the first half of the study (n = 13) than in the second half (n = 8) (98.9 +/- 62.4 min vs 61.7 +/- 17.6 min, P = 0.04), although the specimen size did not differ.


CONCLUSIONS
Training in animal models could help endoscopists overcome the learning curve before starting ESD in humans.
Parra-Blanco
Adolfo
A
Department of Gastroenterology, University Hospital of the Canary Islands, Ofra s/n, La Laguna, 38320 Tenerife, Spain. parrablanco@hotmail.com
Arnau
María Rosa
MR
Nicolás-Pérez
David
D
Gimeno-García
Antonio Z
AZ
González
Nicolás
N
Díaz-Acosta
Juan A
JA
Jiménez
Alejandro
A
Quintero
Enrique
E
D000818:Animals; D013505:Digestive System Surgical Procedures / Q000193:education*; D004210:Dissection / Q000193:education; D004502:Education, Medical, Continuing; D004945:Esophagoscopy; D005260:Female; D005753:Gastric Mucosa / Q000601:surgery; D005770:Gastrointestinal Neoplasms / Q000601:surgery; D005773:Gastroscopy; D006801:Humans; D023421:Models, Animal; D013030:Spain; D034421:Sus scrofa / Q000601:surgery*