Experimental gastric endoscopic submucosal dissection: training in a porcine model

Authors Panagiotis Kasapidis, Stefanos Bassioukas, Georgios Mavrogenis, Georgios Tribonias, Konstantinos Delis, Sotirios Georgopoulos, Dimitrios Christodoulou, Theodoros Emmanouil, Konstantina Paraskeva, Vassilios Panteris, Apostolos Papalois, John Triantafillidis, Zacharias Tsiamoulos, Takataro Fukuhara, Yoriaki Komeda, Hiroshi Kashida.


Background Endoscopic submucosal dissection (ESD) requires special skills and a long procedure time for a quality-controlled procedure. A universal training system remains to be established. Hands-on courses in animal models before advancing to the human colon appear to be essential, especially in Europe. The learning curve is a prerequisite in ESD, in order to improve technical outcomes and decrease the rate of procedural adverse events.

Methods In the experimental research center of ELPEN Pharmaceuticals, 18 European endoscopists, inexperienced at ESD, performed gastric ESDs in porcine models. The course lasted two days and was conducted under the supervision of experts.

Results A total of 72 of 76 ESDs were completed en bloc (94.7%). The procedural time and cutting speed differed significantly between the first and second day: 48±4.4 vs. 43±4.8 min (P=0.0045), and 1.38±0.20 vs. 1.63±0.23 cm2/min (P=0.0033), respectively. The complications were not significantly different between the two groups: five (13.88%) vs. four (11%) episodes of bleeding (P>0.05). The perforation rate was similar, at two episodes per day (5.55%). We documented an acceptable rate of en bloc resections and complications.

Conclusion ESD demands a new level of endoscopic skills in Europe. A formal sequential training program, using porcine models, may benefit countries with a low volume of cases.

Keywords Endoscopic submucosal dissection, animal models, ESD training, hands-on course, procedural time

Ann Gastroenterol 2017; 30 (4): 446-449

Original Articles