Endoscopic submucosal dissection training with pig models in a Western country

Abstract

To test a strategy for endoscopic submucosal dissection (ESD) training in animal models designed to overcome the initial learning curve. ESD was attempted in ex vivo and in vivo pig models. Thirty ESD procedures were attempted in the esophagus (n = 9) or the stomach (n = 21). The ex vivo model was used until initial competence was achieved. In the in vivo model, several ESD procedures were performed in up to 3 sessions. The following variables were analyzed: specimen size, complete and en bloc resection rate, time for circumferential incision, time for submucosal dissection, total ESD duration, and complications. Complete resection was achieved in 28 cases (en bloc 27); 2 could not be completed (one perforation, one technical difficulty). The mean +/- SD time for circumferential incision was 36.2 +/- 16.8 min (range: 8-87 min), and the mean +/- SD time for submucosal dissection was 45.1 +/- 35.7 min (range: 9-196 min). The mean +/- SD size of the resected specimens was 45.2 +/- 17.8 mm. The mean +/- SD total resection time was significantly increased for the gastric cases performed in the first half of the study (n = 13) than in the second half (n = 8) (98.9 +/- 62.4 min vs 61.7 +/- 17.6 min, P = 0.04), although the specimen size did not differ. Training in animal models could help endoscopists overcome the learning curve before starting ESD in humans.