Learning Curve in a Western Training Center of the Circumferential En Bloc Esophageal Endoscopic Submucosal Dissection in an In Vivo Animal Model

Abstract

Aim. Evaluate the feasibility to overcome the learning curve in a western training center of the en bloc circumferential esophageal (ECE-) ESD in an in vivo animal model. Methods. ECE-ESD was performed on ten canine models under general anesthesia on artificial lesions at the esophagus marked with coagulation points. After the ESD each canine model was euthanized and surgical resection of the esophagus and stomach was carried out according to “the Principles of Humane Experimental Technique, Russel and Burch.” The specimen was fixed with needles on cork submerged in formalin with the esophagus and stomach then delivered to the pathology department to be analyzed. Results. ECE-ESD was completed without complications in the last 3/10 animal models. Mean duration for the procedures was 192 ± 35 minutes (range 140–235 minutes). All the procedures were done at the animal lab surgery room with cardio pulmonary monitoring and artificial ventilation by staff surgery members and a staff member of the Gastroenterology department trained during 1999–2001 at the Fujigaoka hospital of the Showa U. in Yokohama, Japan, length (range 15–18 mm) and 51 ± 6.99 width (range 40–60 mm). Conclusion. ECE-ESD training is feasible in canine models for postgraduate endoscopy fellows.

Ex VivoandIn VivoModels for Endoscopic Submucosal Dissection Training

“…An endoscopist with previous training in an important endoscopy teaching center in Japan performed gastric ESDs in mongrel dogs that weighed 18 to 20 kg, either with a Hook knife or an IT-knife, successfully, and without any complications. The same group proved the feasibility of a similar canine model to train in circumferential esophageal ESD 23. Moreover, a learning curve was proven, as perforations occurred in the initial seven cases, whereas the last three cases were completed uneventfully.…”

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

“…Thus, the necessity of specific training before embarking on the procedure in humans is evident. It has been reported that training for esophageal ESD in an anesthetized live pig is a valuable option [26][27][28]. However, the number of institutions that can offer training using live pigs is limited because their use requires expensive instrument and special facilities.…”

“…Previous reports clarified the usefulness of a live animal model for learning ESD [26][27][28]. However, live animal models are expensive and not all institutions or hospitals are equipped for their usage.…”

Percutaneous transgastric traction-assisted esophageal endoscopic submucosal dissection: a randomized controlled trial in a porcine model

“…However, ESD is time consuming and associated with a higher rate of adverse events, such as perforation, bleeding, and esophageal stricture [3,8,9,18]. The ESD procedure is laborious and requires a high level of skill, and acquiring the ability to perform ESD involves a slow learning curve [19]. The incidence of procedure-related adverse events is highly dependent on operator proficiency.…”