Experimental Endoscopic Submucosal Dissection Training in a Porcine Model: Learning Experience of Skilled Western Endoscopists

Berr, Frieder; Ponchon, Thierry; Neureiter, Daniel; Kiesslich, Tobias; Haringsma, Jelle; Kaehler, Georg; Schmoll, F.; Messmann, Helmut; Yahagi, Naohisa; Oyama, Tsuneo

doi:10.1111/j.1443-1661.2011.01129.x

Cited by 84 publications

(72 citation statements)

References 34 publications

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“…In the West, opportunities to pursue ESD training using the Japanese training algorithm have been limited by the low rates of early gastric cancer and thus the inability to enter the ESD learning curve at the relatively safest location [19,32] . To master the techniques of ESD, particularly in areas with a low incidence of early GI cancers, it was recommended to formulate a standardized protocol for training following the Japanese training model.…”

Section: Esd Training In the Westmentioning

confidence: 99%

“…However, one of the main perceived disadvantages is that the ex-vivo animal models do not help in acquiring the skills of hemostasis and approaching a deep enough level of the submucosal layer, because bleeding does not occur [32] . The live pig model simulates a more realistic endoscopy setting and provides the opportunity to respond to and treat potential complications including bleeding and perforation [19] . However, some of the differences between pig and human stomach, such infrequent bleeding and lack of fibrosis in the pig stomach might make the procedure less challenging than in humans.…”

Section: Esd Training In the Westmentioning

confidence: 99%

“…Despite its obvious advantages, ESD is one of the most complex endoscopic techniques, with several technical difficulties to overcome and potentially high complication rates, especially in the beginning of the learning curve [18][19][20] . The most frequent complications are bleeding and perforation.…”

Section: Introductionmentioning

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%

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Training in endoscopic submucosal dissection

Coman

Gotoda²,

Draganov³

2013

WJGE

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show abstract

“…After some practice, the trainee can move on to the in vivo animal model, where the endoscopist may experience a sense of reality of complications such as bleeding and perforation (151)(152)(153). After having completed several gastric cases, the trainee may move to different locations: Esophagus, rectum (148). There are some encouraging reports which have shown that a high level of competence, with 100 % en-bloc resection rate, could be achieved by non-supervised Western endoscopists after completing 30 ESD cases in the ex vivo gastric animal model (154).…”

Section: Training In Esdmentioning

confidence: 99%

“…The skills required for ESD performance are commonly achieved after a long learning curve under expert´s tutoring (136)(137). There are recommendations regarding training in ESD, both in Asiatic and Western countries (138)(139)(140)(141)(142)(143)(144)(145)(146)(147)(148)(149)(150). Animal training under expert´s supervision is essential, since it allows the trainee to overcome some of the limitations in learning ESD in real patients (150)(151).…”

Section: Training In Esdmentioning

confidence: 99%