Endoscopic submucosal dissection training with ex vivo human gastric remnants

Abstract

ESD requires the endoscopist to perform a surgical dissection. Until now, development of these skills required intensive training on porcine models that are not widely available. We were able to create a method using the excised portion from sleeve gastrectomy patients, providing a more accessible and cost-effective model for ESD training and potentially other endoscopic therapeutic modalities.

Efficacy of a three‐day training course in endoscopic submucosal dissection using a live porcine model: a prospective evaluation

“…The adjusted mean dissection speed found in our study (22.1 mm 2 /minute) was very close to that reported by Jacques et al. (23.3 mm 2 /minute) in a similar porcine model 14 . We believe that, with experience, the junior endoscopist not only progresses in organising different strategies to resect ‘lesions’ of different sizes and locations, but also very practically in the use of ESD‐associated devices.…”

“…This might be due to a lack of attention during the procedure or, more likely, to an excess of confidence of the endoscopist. The complication rate reported in our study was much lower than that found in other pig models 14 . This might reflect the fact that ‘junior’ endoscopists were carefully selected for ESD training and had mostly already performed endoscopic retrograde cholangiopancreatography or other interventional techniques.…”

“…The adjusted mean dissection speed found in our study (22.1 mm 2 /minute) was very close to that reported by Jacques et al (23.3 mm 2 /minute) in a similar porcine model. 14 We believe that, with experience, the junior endoscopist not only progresses in organising different strategies to resect 'lesions' of different sizes and locations, but also very practically in the use of ESD-associated devices. For instance, it is striking to note how trainees quickly learn how to use the cap to stabilise the tip of the endoscope, the waterjet knife to clean the working space and re-inject the submucosa with the correct amount of fluid, and to manipulate haemostatic forceps or clips when necessary.…”

“…Those ex vivo models are widely used, and are also very useful in the multistep learning process of ESD but are quite artificial. Some authors have recently proposed using a human gastric remnant from sleeve gastrectomy that allows them to surround some inconvenience of the porcine model (such as the thickness of the porcine gastric mucosa, as discussed below) and provide an accessible and cost‐effective model 14 . Indeed, ESD procedures performed in the stomach of healthy pigs do not reflect the complexity of ESD procedures in human diseases.…”

Current controversies in treating remnant gastric cancer: Are minimally invasive approaches feasible?

“…Moreover, Fukui et al[30] have found that complete gastrectomy does not improve survival outcomes compared with ESD, and complete gastrectomy may even adversely affect the long-term outcomes of patients with early RGC. However, performing ESD in the remnant stomach is challenging due to the narrow workspace and the presence of severe fibrosis, adhesions and staples under the suture lines[31,32]. We reviewed all published English language literature to assess the efficacy and feasibility of ESD in treating early RGC.…”