Ex vivo pig training model for esophageal endosopic submucosal dissection (ESD) for endoscopists with experience in gastric ESD

Tanaka, Shinwa; Morita, Yoshinori; Fujita, Tsuyoshi; Wakahara, Chika; Ikeda, Atsuki; Toyonaga, Takashi; Azuma, Takeshi

doi:10.1007/s00464-011-2074-6

Cited by 31 publications

(24 citation statements)

References 30 publications

(34 reference statements)

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“…In ESD, a clinical situation can be easily simulated by making artificial lesions at preferred sites, and the usefulness of ESD training models using a porcine stomach has been demonstrated in many studies [5,6]. However, no studies have reported training models for treating esophageal varices.…”

Section: Discussionmentioning

confidence: 99%

Ex vivo Comparison Study of Smart Shooter®, a New Endoscopic Device for Safe and Speedy Treatment

Kikuchi

Kuribayashi²,

Iizuka³

et al. 2015

Digestion

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Background: In many endoscopic procedures, the operative view can be compromised when manipulating the treatment device because the endoscopists must release their hand from the endoscope. We have developed a new device called the Smart Shooter® (SS) for simultaneous manipulation of the endoscope and treatment device, and evaluated the utility of the SS compared with the conventional method. Methods: The SS is a semirigid, loop-shaped channel extender that enables endoscopists to manipulate the treatment device with the thumb of the right hand while holding the endoscope with the same hand. We conducted a comparative study of gastric endoscopic submucosal dissection (ESD) and esophageal injection sclerotherapy (EIS) in a porcine model to compare the utility of the SS method with the conventional method. Results: In gastric ESD, all lesions were resected en bloc with no perforation. The mean operative time was significantly shorter with the SS method than with the conventional method (287.5 ± 155.4 vs. 403.5 ± 215.6 s, p = 0.04). In esophageal EIS, 4 paravenous injections were given with the SS method and 5 were given using the conventional method. Similarly, the mean operative time was significantly shorter with the SS method than with the conventional method (19.0 ± 7.8 vs. 23.8 ± 10.0 s, p = 0.04). Conclusion: Use of the SS enabled a shorter operative time for gastric ESD and esophageal EIS with no adverse events. The present results suggest that the SS can contribute to safe and speedy endoscopic treatment.

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Section: Discussionmentioning

confidence: 99%

Ex vivo Comparison Study of Smart Shooter®, a New Endoscopic Device for Safe and Speedy Treatment

Kikuchi

Kuribayashi²,

Iizuka³

et al. 2015

Digestion

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“…Animal models could be used not only for training in gastric ESD but also for esophageal and colonic ESD [66][67][68][69] . Tanaka et al [67] developed an original training model for esophageal ESD using isolated pig esophagus and assessed this ex-vivo model in endoscopists with experience in gastric ESD.…”

Section: Esd Training In the Westmentioning

confidence: 99%

“…Tanaka et al [67] developed an original training model for esophageal ESD using isolated pig esophagus and assessed this ex-vivo model in endoscopists with experience in gastric ESD. 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.…”

Section: Esd Training In the Westmentioning

confidence: 99%

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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“…A specific model for esophageal ESD has been described recently 13. A double overtube system was used to make the model more stable and to prevent the esophagus from sliding with the movements of the endoscope.…”

Section: Ex Vivo Modelmentioning

confidence: 99%

Ex VivoandIn VivoModels for Endoscopic Submucosal Dissection Training

2012

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Endoscopic submucosal dissection is a technically challenging but highly effective technique for the treatment of well selected early neoplasms in the digestive tract. Although it is frequently performed in East Asian countries, the Western world has not adopted this technique yet, probably due in part to the difficulty to learn it. Ex vivo and in vivo animal models are invaluable tools to overcome at least the beginning of the learning curve, although the initial step is the acquisition of basic knowledge about early diagnosis of neoplasias, and observing real procedures in expert centers. The practical issues, advantages, and disadvantages of the ex vivo and in vivo models are discussed.

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Ex vivo pig training model for esophageal endosopic submucosal dissection (ESD) for endoscopists with experience in gastric ESD

Abstract: This original ex vivo training model was helpful to endoscopists with experience in gastric ESD in acquiring the basic skills for performing esophageal ESD.

Cited by 31 publications

References 30 publications

Ex vivo Comparison Study of Smart Shooter®, a New Endoscopic Device for Safe and Speedy Treatment

Ex vivo Comparison Study of Smart Shooter®, a New Endoscopic Device for Safe and Speedy Treatment

Training in endoscopic submucosal dissection

Ex VivoandIn VivoModels for Endoscopic Submucosal Dissection Training

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