Endoscopic submucosal dissection training with pig models in a Western country

Parra‐Blanco, Adolfo; Arnau, María Rosa; Nicolás–Pérez, David; Gimeno–García, Antonio Z.; Gónzalez, Nicolás; Díaz-Acosta, Juan A; Jiménez, A. Muñoz; Quintero, Enrique

doi:10.3748/wjg.v16.i23.2895

Cited by 85 publications

(86 citation statements)

References 16 publications

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“…While training in animal models may not be needed in Japanese institutions where supervision by experts is easily available, these models can be a valuable resource when training in the West. Models could allow endoscopists to ascend the learning curve in a relatively short time, especially when training in low volume centers or/and without direct expert supervision [32,37,63,64] . Two prospective studies were aimed in determining the results, efficacy, and safety of ESD performed in pigs by an endoscopist at the beginning of the learning curve prior to its application in humans.…”

Section: Esd Training In the Westmentioning

confidence: 99%

“…The studies showed that training in pigs could be started without such previous learning, and may augment the acquisition of skills in low-volume centers. However, ESD involves maneuvers that traditionally have not been used during flexible endoscopy, which would be difficult to master by oneself [64,65] . The harvested porcine organs are ready-to-use and inexpensive means of becoming proficient in these techniques.…”

Section: Esd Training In the Westmentioning

confidence: 99%

“…The operation time and number of muscularis propria layer injuries decreased gradually as endoscopists gained training experience, while the mean number of muscularis propria layer injuries significantly decreased for all of the endoscopists in the latter period compared with the former period. While it has been demonstrated that certain skills can be acquired during self-guided animal model training, learning from experts appears crucial to achieve the ability to perform ESD safely in humans [64] . Therefore observing experts and performing ESD under expert supervision in addition to practicing on animal model appears a necessary step while training in the West [31,[70][71][72] .…”

Section: Esd Training In the Westmentioning

confidence: 99%

“…Other possible strategies would be to organize training courses (with animal and/or human training) under the supervision of experts, or to attempt ESD procedures supervised by means of a videoconference. However, the impact of these methods on ESD performance has yet to be determined [64] . Such, Western and Asian centers should collaborate closely in terms of training, exchange of data, and initiation of international multicenter trials [60] .…”

Section: Esd Training In the Westmentioning

confidence: 99%

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Training in endoscopic submucosal dissection

Coman

Gotoda²,

Draganov³

2013

WJGE

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Endoscopic submucosal dissection (ESD) represents an important advancement in the therapy of early neoplastic gastrointestinal lesions by providing higher en-bloc curative resection rate with lower recurrence compared to endoscopic mucosal resection (EMR) and by sparing the involved organ and protecting patient' s quality of life. Despite these advantages ESD is associated with long procedure times and a higher rate of complications, making ESD a challenging procedure which requires advanced endoscopic skills. Thus, there has been a recognized need for structured training system for ESD to enhance trainee experience and, to reduce the risks of complications and inadequate treatment. ESD has a very flat learning curve. However, we do not have uniformly accepted benchmarks for competency. Nevertheless, it appears that, in Japan, more than 30 supervised gastric ESD procedures are required to achieve technical proficiency and minimize complications. A number of training algorithms have been proposed in Japan with the aim to standardize ESD training. These algorithms cannot be directly applied in the West due to substantial differences including the availability of highly qualified mentors, the type of pathology seen, choice of devices, and trainee's background. We propose a training algorithm for Western physicians which integrates both hands-on training courses, animal model work as well as visits to expert centers. No specific preceptor training programs have been yet developed but there is a consensus that these programs are important for permeation of ESD worldwide. Key words: Endoscopic submucosal dissection; Training; Learning curve; Early gastrointestinal cancer; Endoscopic mucosal resection Core tip: Endoscopic submucosal dissection (ESD) is a complex procedure associated with high complication rate. In Japan, training in ESD follows the traditional mentor/apprentice approach but significant variability in training approaches exists. We review the learning curves for ESD and describe the training algorithm proposed in Japan aiming to standardize training, and its applicability in the West. We highlight the challenges for ESD dissemination in the West, describing both the consensus and the diverging opinions between Asian and Western training models. Finally, we emphasize the need for structured training system to enhance trainee experience and, most importantly, to reduce the risks of complications and inadequate treatment.Coman RM, Gotoda T, Draganov PV. Training in endoscopic submucosal dissection. World J Gastrointest Endosc 2013; 5(8): 369-378 Available from:

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Section: Esd Training In the Westmentioning

confidence: 99%

Section: Esd Training In the Westmentioning

confidence: 99%

Section: Esd Training In the Westmentioning

confidence: 99%

Section: Esd Training In the Westmentioning

confidence: 99%

See 2 more Smart Citations

Training in endoscopic submucosal dissection

Coman

Gotoda²,

Draganov³

2013

WJGE

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show abstract

“…The in-vivo pig model has proven to be adequate for endoscopic training in the upper digestive tract [3,4]. Anatomy of the pig´s stomach is quite similar to the human anatomy, even though it has a stronger and protruding Pylorus (Torus Pyloricus) [5].…”

Section: Introductionmentioning

confidence: 99%