title: Gastric endoscopic submucosal dissection: from animal model to patient.
abstract: OBJECTIVE
  To assess whether the use of porcine models is useful for learning endoscopic submucosal dissection (ESD), thus contributing to its subsequent application in human patients.
  
  
  METHODS
  This study/learning process was carried out in 3 phases: Phase I: Ex vivo animal; Phase II: In vivo animal; Phase III: Humans. One endoscopist performed 30 gastric ESDs in porcine models, and later 5 gastric ESDs in 5 patients. The ESD was done following the method practiced at the National Cancer Center in Tokyo, Japan. Technical aspects, size, time and speed of ESD, as well as complications were registered. In patients, their clinical, endoscopic and histologic evolution was additionally added.
  
  
  RESULTS
  Thirty en bloc ESDs were carried out in animal models. The mean ± SD size of the pieces was of 28.4 ± 1.2 mm, and the time of ESD was 41.7 ± 2.4 min. The time of ESD in the first 15 procedures was 43.0 ± 3.0 min whereas in the next 15 procedures, the time was 40.3 ± 3.9 min, P = 0.588. The speed in the first 15 ESDs was 1.25 ± 0.11 cm(2)/min vs 2.12 ± 0.36 cm(2)/min in the remaining 15, P = 0.028. There were no complications. In patients, 5 lesions were resected en bloc. The size of the pieces was 25.2 ± 5.1 mm and the time was 85.0 ± 25.6 min. Endoscopic and histological controls did not show evidence of residual neoplastic tissue.
  
  
  CONCLUSIONS
  A sequential ESD training program of a unique endoscopist, based on the practice in porcine models, contributed to learning ESD for its subsequent application in humans, yielding good results in efficacy and safety.
authors.affiliation: Nicolás González, Miguel Villa-Gómez, Alejandra Gamba, Andrés Taullard, Alberto Sanguinetti, Carolina Olano, Henry Cohen, Department of Gastroenterology, Faculty of Medicine, Hospital de Clínicas, Montevideo 11600, Uruguay.
authors.forename: Nicolás
authors.initials: N
authors.lastname: González
authors.affiliation: Nicolás González, Miguel Villa-Gómez, Alejandra Gamba, Andrés Taullard, Alberto Sanguinetti, Carolina Olano, Henry Cohen, Department of Gastroenterology, Faculty of Medicine, Hospital de Clínicas, Montevideo 11600, Uruguay.
authors.forename: Adolfo
authors.initials: A
authors.lastname: Parra-Blanco
authors.affiliation: Nicolás González, Miguel Villa-Gómez, Alejandra Gamba, Andrés Taullard, Alberto Sanguinetti, Carolina Olano, Henry Cohen, Department of Gastroenterology, Faculty of Medicine, Hospital de Clínicas, Montevideo 11600, Uruguay.
authors.forename: Miguel
authors.initials: M
authors.lastname: Villa-Gómez
authors.affiliation: Nicolás González, Miguel Villa-Gómez, Alejandra Gamba, Andrés Taullard, Alberto Sanguinetti, Carolina Olano, Henry Cohen, Department of Gastroenterology, Faculty of Medicine, Hospital de Clínicas, Montevideo 11600, Uruguay.
authors.forename: Alejandra
authors.initials: A
authors.lastname: Gamba
authors.affiliation: Nicolás González, Miguel Villa-Gómez, Alejandra Gamba, Andrés Taullard, Alberto Sanguinetti, Carolina Olano, Henry Cohen, Department of Gastroenterology, Faculty of Medicine, Hospital de Clínicas, Montevideo 11600, Uruguay.
authors.forename: Andrés
authors.initials: A
authors.lastname: Taullard
authors.affiliation: Nicolás González, Miguel Villa-Gómez, Alejandra Gamba, Andrés Taullard, Alberto Sanguinetti, Carolina Olano, Henry Cohen, Department of Gastroenterology, Faculty of Medicine, Hospital de Clínicas, Montevideo 11600, Uruguay.
authors.forename: Anaulina
authors.initials: A
authors.lastname: Silveira
authors.affiliation: Nicolás González, Miguel Villa-Gómez, Alejandra Gamba, Andrés Taullard, Alberto Sanguinetti, Carolina Olano, Henry Cohen, Department of Gastroenterology, Faculty of Medicine, Hospital de Clínicas, Montevideo 11600, Uruguay.
authors.forename: Alberto
authors.initials: A
authors.lastname: Sanguinetti
authors.affiliation: Nicolás González, Miguel Villa-Gómez, Alejandra Gamba, Andrés Taullard, Alberto Sanguinetti, Carolina Olano, Henry Cohen, Department of Gastroenterology, Faculty of Medicine, Hospital de Clínicas, Montevideo 11600, Uruguay.
authors.forename: Carolina
authors.initials: C
authors.lastname: Olano
authors.affiliation: Nicolás González, Miguel Villa-Gómez, Alejandra Gamba, Andrés Taullard, Alberto Sanguinetti, Carolina Olano, Henry Cohen, Department of Gastroenterology, Faculty of Medicine, Hospital de Clínicas, Montevideo 11600, Uruguay.
authors.forename: Henry
authors.initials: H
authors.lastname: Cohen
mesh_terms: D000818:Animals; D002983:Clinical Competence; D004210:Dissection / Q000009:adverse effects / Q000193:education* / Q000379:methods; D004501:Education, Medical / Q000379:methods*; D005773:Gastroscopy / Q000009:adverse effects / Q000193:education*; D006801:Humans; D059032:Learning Curve; D023421:Models, Animal; D009048:Motor Skills; D018365:Neoplasm, Residual; D011446:Prospective Studies; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D013552:Swine; D013647:Task Performance and Analysis; D013997:Time Factors; D014583:Uruguay
keywords: Animal models; Endoscopic submucosal dissection; Porcine models; Training