title: Experimental endoscopic submucosal dissection training in a porcine model: learning experience of skilled Western endoscopists.
abstract: BACKGROUND
  Endoscopic submucosal dissection (ESD) demands a new level of endoscopic skill in Europe. A 2-day workshop was set up for trainees to carry out five ESD each in order to obtain the skill level required to perform ESD in the stomach or rectum. This study describes: (i) the workshop setup; (ii) the participant's performance; and (iii) the training effect on post-workshop clinical ESD performance.
  
  
  METHODS
  Eighteen very experienced European endoscopists participated in four half-day (4.5 h) training sessions, with everybody rotating daily through six separate training stations (two each with dual, hook, or hybrid knives) with expert tutors. One anesthetized piglet was used per station and session. After 1 year, the clinical ESD performance was surveyed to estimate the training effect of the workshop.
  
  
  RESULTS
  Overall, 74 ESD were performed, that is, 4.1 ESD per participant. On average ESD lasted 57 min for 6 cm(2) specimens. We detected a 22% rate of perforation (16 of 74 ESD with perforations), mostly attributable to participants with less experience in ESD. Those who started clinical ESD within 1 year after the workshop performed 144 clinical ESD (median 8 [0-20] per trainee) mostly in the stomach (40%) and large bowel (46%) with an acceptable rate of perforation (9.7%) and surgical repair (3.5%) without mortality or persistent morbidity.
  
  
  CONCLUSIONS
  Intense skill training for ESD is needed to reduce the risk of perforation, as demonstrated by the results of this workshop. We show that experimental ESD training, however, enables skilled European endoscopists to perform ESD in standard locations with moderate risk of perforation during the clinical learning curve.
authors.affiliation: Department of Medicine I, Paracelsus Medical University/Salzburger Landeskliniken (SALK), Muellner Hauptstrasse 48, 5020 Salzburg, Austria. f.berr@salk.at
authors.forename: Frieder
authors.initials: F
authors.lastname: Berr
authors.forename: Thierry
authors.initials: T
authors.lastname: Ponchon
authors.forename: Daniel
authors.initials: D
authors.lastname: Neureiter
authors.forename: Tobias
authors.initials: T
authors.lastname: Kiesslich
authors.forename: Jelle
authors.initials: J
authors.lastname: Haringsma
authors.forename: Georg F
authors.initials: GF
authors.lastname: Kaehler
authors.forename: Friedrich
authors.initials: F
authors.lastname: Schmoll
authors.forename: Helmut
authors.initials: H
authors.lastname: Messmann
authors.forename: Naohisa
authors.initials: N
authors.lastname: Yahagi
authors.forename: Tsuneo
authors.initials: T
authors.lastname: Oyama
mesh_terms: D000328:Adult; D000818:Animals; D002983:Clinical Competence; D004210:Dissection / Q000193:education*; D004724:Endoscopy / Q000193:education*; D005753:Gastric Mucosa / Q000601:surgery*; D006801:Humans; D007413:Intestinal Mucosa / Q000601:surgery*; D008875:Middle Aged; D023421:Models, Animal; D011183:Postoperative Complications; D013552:Swine