Ex Vivo Porcine Model Study on the Treatment Outcomes of Scissor-type Knife Versus Needle-type Knife in Endoscopic Submucosal Dissection Performed by Trainees

Abstract

BackgroundTrainee endoscopists find endoscopic submucosal dissection (ESD) for gastrointestinal neoplasms difficult to perform independently; furthermore, there is no consensus on which endo-knife type is the most suitable for them. Therefore, we conducted a prospective study comparing the treatment outcomes of scissor-type and needle-type knives in ESD performed by trainees in an ex vivo porcine model.MethodsAround 22 trainees from 13 institutions, divided into two groups according to their endoscopic experience, performed ESD in a porcine model. Each trainee performed two ESDs under expert supervision: one with a scissor-type knife (ESD-S) and the other with a needle-type knife (ESD-N). The efficacy and safety, including the procedure time and rates of self-completion, en bloc resection, and complications, were compared between ESD-S and ESD-N. ResultsEight trainees had an experience of over 1,000 endoscopies (senior trainee: S-Trainee), whereas the remaining had an experience of less than 1,000 endoscopies (junior trainee: J-Trainee). Among the S-Trainees, no significant differences were observed in any treatment outcome between ESD-S and ESD-N. Among the J-Trainees, the total procedure and mucosal incision times were significantly shorter in ESD-S than in ESD-N [total procedure time: 16.5 min (range: 10.0–31.0) vs. 22.3 min (range: 10.0–38.0), P = 0.018; circumferential incision time: 10.0 min (range: 6-16) vs. 17.0 min (range: 5.0–31.5); P = 0.019]. Regarding complications, muscular injury occurred in two patients during ESD-N performed by J-Trainees; however, no muscular injury occurred during ESD-S.ConclusionsS-Trainees could perform ESD safely in an ex vivo porcine model under expert supervision, regardless of the endo-knife type used. However, the scissor-type knife is desirable if J-Trainees were to perform the ESD procedure.