Simulating a target lesion for endoscopic submucosal dissection training in an ex vivo pig model

Wang, Tsang-En; Wang, Horng‐Yuan; Lin, Chao-Cheng; Chen, Tung-Ying; Chang, Ching-Wei; Chen, Chih‐Jen; Chen, Ming‐Jen

doi:10.1016/j.gie.2011.04.014

Cited by 23 publications

(18 citation statements)

References 9 publications

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“…24,25 Accordingly, in our study, wall structure of organ, mucosal thickness and tissue pliability scored the lowest mean values, although medians were comparable. This seems in line with the study by Horii et al where mucosal layer of the porcine was found to be thinner in the proximal stomach and thicker in the distal area, particularly at the level of the greater curvature, where ESD speed is lower and difficulty is greater when compared to human procedures.…”

Section: Discussionmentioning

confidence: 45%

Training in endoscopic mucosal resection and endoscopic submucosal dissection: Face, content and expert validity of the live porcine model

et al. 2018

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Introduction: Endoscopic mucosal resection and endoscopic submucosal dissection are demanding procedures. This study aims to establish face, content and expert validity of the live porcine model in performing endoscopic mucosal resection, endoscopic submucosal dissection, complication management and to assess it as a training tool. Material and methods: Tutors and trainees participating in live porcine model endoscopic mucosal resection and endoscopic submucosal dissection workshops filled out a questionnaire regarding the realism of the model compared to human setting and its role as a learning tool. A 10-point Likert scale was used. Results: Ninety-one endoscopists (13 tutors; 78 trainees) were involved in four workshops. Median global classifications for the realism of the life porcine model ranged between 7.0-8.0 (interquartile range 5.0-9.0). Procedures resembled human cases with a median of 9.0 (8.0-9.0) for oesophageal multiband endoscopic mucosal resection; 8.5 (8.0-9.0) for oesophageal endoscopic submucosal dissection; 9.0 (8.0-10.0) for gastric endoscopic submucosal dissection; and 9.0 (8.5-9.75 and 8.0-9.69) for complication detection and management. The animal model as a learning tool had median scores of 9.0 (7.0-10.0) considering how procedures are performed; 9.0-9.5 (8.0-10.0) for usefulness for beginners; and 9.0-10.0 (5.0-10.0) regarding it a prerequisite. Conclusions: Training in a live porcine model was considered very realistic compared to the human setting and was highly appreciated as a learning tool. This is the first study to establish face, content and expert validity of the live porcine model in performing multiband endoscopic mucosal resection, oesophageal and gastric endoscopic submucosal dissection. The validation of this model provides the rationale to incorporate it into formal teaching programmes.

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Section: Discussionmentioning

confidence: 45%

Training in endoscopic mucosal resection and endoscopic submucosal dissection: Face, content and expert validity of the live porcine model

et al. 2018

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“…Two lesion types are considered in order to evaluate the benefits of chromoendoscopy with the proposed modified protocol: pseudopolyps to simulate a protruding (0-lp) lesion and non-protruding slightly depressed lesions of type 0-IIc. In [35] a method is described to create a pseudopolyp using an esophageal variceal ligation device. We used a similar approach but employed a suture to perform a ligation of the stomach mucosa in order to create a pseudopolyp.…”

Section: Methodsmentioning

confidence: 99%

Chromoendoscopy in magnetically guided capsule endoscopy

Mewes

Foertsch

Juloski

et al. 2013

BioMedical Engineering OnLine

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BackgroundDiagnosis of intestinal metaplasia and dysplasia via conventional endoscopy is characterized by low interobserver agreement and poor correlation with histopathologic findings. Chromoendoscopy significantly enhances the visibility of mucosa irregularities, like metaplasia and dysplasia mucosa. Magnetically guided capsule endoscopy (MGCE) offers an alternative technology for upper GI examination. We expect the difficulties of diagnosis of neoplasm in conventional endoscopy to transfer to MGCE. Thus, we aim to chart a path for the application of chromoendoscopy on MGCE via an ex-vivo animal study.MethodsWe propose a modified preparation protocol which adds a staining step to the existing MGCE preparation protocol. An optimal staining concentration is quantitatively determined for different stain types and pathologies. To that end 190 pig stomach tissue samples with and without lesion imitations were stained with different dye concentrations. Quantitative visual criteria are introduced to measure the quality of the staining with respect to mucosa and lesion visibility. Thusly determined optimal concentrations are tested in an ex-vivo pig stomach experiment under magnetic guidance of an endoscopic capsule with the modified protocol.ResultsWe found that the proposed protocol modification does not impact the visibility in the stomach or steerability of the endoscopy capsule. An average optimal staining concentration for the proposed protocol was found at 0.4% for Methylene blue and Indigo carmine. The lesion visibility is improved using the previously obtained optimal dye concentration.ConclusionsWe conclude that chromoendoscopy may be applied in MGCE and improves mucosa and lesion visibility. Systematic evaluation provides important information on appropriate staining concentration. However, further animal and human in-vivo studies are necessary.

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“…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%

Endoscopic submucosal dissection: Sociedad Española de Endoscopia Digestiva (SEED) clinical guideline

Fernández‐Esparrach¹,

Calderón

Peña

et al. 2014

Rev. esp. enferm. dig.

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Simulating a target lesion for endoscopic submucosal dissection training in an ex vivo pig model

Cited by 23 publications

References 9 publications

Training in endoscopic mucosal resection and endoscopic submucosal dissection: Face, content and expert validity of the live porcine model

Training in endoscopic mucosal resection and endoscopic submucosal dissection: Face, content and expert validity of the live porcine model

Chromoendoscopy in magnetically guided capsule endoscopy

Endoscopic submucosal dissection: Sociedad Española de Endoscopia Digestiva (SEED) clinical guideline

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