title: New isolated bovine colon model dedicated to colonic ESD hands-on training: development and first evaluation.
abstract: BACKGROUND
  ESD is the reference method to achieve en bloc resections for large digestive lesions. Nevertheless, it is a difficult and risky technique. Animal models exist to teach the initial skills, particularly in Japan, where pigs' stomachs are dedicated models to gastric ESD. In Europe, we have to develop different strategies of teaching with dedicated colon models. A pig colon is a good model but thinner and narrower than a human's. In this present work, we evaluated a bovine colon model to perform rectal ESD in retroflexion.
  
  
  METHODS
  First, we prepared six bowels to precise the preparation protocol. Then, two endoscopists unexperienced in ESD performed 64 procedures on eight models. Learning curves and factors of variation were studied.
  
  
  RESULTS
  A precise protocol to prepare the colon was defined. The two students achieved en bloc resection in 89.1 % of cases with a rate of 6.2 % of perforations. A large heterogeneity appeared between the speed and the success rate depending mainly on the age of the animal bowel. Using calf colons, the failure rates were higher (p = 0.002) and the speed was lower (p < 0.001) than for adult bovine ones. A learning curve appeared with, respectively, 0.49 and 0.59 cm(2)/min throughout the study. No significant difference appeared between measured and calculated specimen areas.
  
  
  CONCLUSIONS
  Bovine colon is a new model to teach ESD in colorectal conditions. The bovine age is important to homogenize the model. A learning curve existed with a time procedure decreasing throughout the study. Further studies are needed to evaluate the precise learning curve with more students.
  
  
  CONCLUSIONS
  A bovine colon model is a suitable model to teach colorectal ESD. Nevertheless, an adult bovine colon model is more homogeneous than a calf one.
authors.affiliation: Gastroenterology and Endoscopy Unit, Digestive Disease Department, H Pavillon- Edouard Herriot Hospital, 69437, Lyon Cedex, France. mathieu.pioche@chu-lyon.fr.|Endoscopy Unit, Cancer Center Keio University, Tokyo, Japan. mathieu.pioche@chu-lyon.fr.|Inserm U1032, Labtau, Lyon, France. mathieu.pioche@chu-lyon.fr.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Pioche
authors.affiliation: Gastroenterology and Endoscopy Unit, Digestive Disease Department, H Pavillon- Edouard Herriot Hospital, 69437, Lyon Cedex, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Rivory
authors.affiliation: Gastroenterology and Endoscopy Unit, Digestive Disease Department, H Pavillon- Edouard Herriot Hospital, 69437, Lyon Cedex, France.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Aguero-Garcete
authors.affiliation: Gastroenterology and Endoscopy Unit, Digestive Disease Department, H Pavillon- Edouard Herriot Hospital, 69437, Lyon Cedex, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Guillaud
authors.affiliation: Gastroenterology and Endoscopy Unit, Digestive Disease Department, H Pavillon- Edouard Herriot Hospital, 69437, Lyon Cedex, France.
authors.forename: Marc
authors.initials: M
authors.lastname: O'Brien
authors.affiliation: Inserm U1032, Labtau, Lyon, France.
authors.forename: Cyril
authors.initials: C
authors.lastname: Lafon
authors.affiliation: Rhône Veterinary Authorities, Lyon, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Reversat
authors.affiliation: Endoscopy Unit, Cancer Center Keio University, Tokyo, Japan.
authors.forename: Toshio
authors.initials: T
authors.lastname: Uraoka
authors.affiliation: Endoscopy Unit, Cancer Center Keio University, Tokyo, Japan.
authors.forename: Naohisa
authors.initials: N
authors.lastname: Yahagi
authors.affiliation: Gastroenterology and Endoscopy Unit, Digestive Disease Department, H Pavillon- Edouard Herriot Hospital, 69437, Lyon Cedex, France.|Inserm U1032, Labtau, Lyon, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Ponchon
mesh_terms: D000818:Animals; D002417:Cattle; D003106:Colon / Q000601:surgery*; D003113:Colonoscopy / Q000193:education* / Q000379:methods; D015179:Colorectal Neoplasms / Q000601:surgery*; D004195:Disease Models, Animal; D004210:Dissection / Q000193:education* / Q000379:methods; D004502:Education, Medical, Continuing / Q000379:methods*; D006801:Humans; D007413:Intestinal Mucosa / Q000601:surgery*; D059032:Learning Curve; D009374:Neoplasms, Experimental
keywords: Animal model; Colon neoplasia; ESD; Training