Development and use of a non-biomaterial model for hands-on training of endoscopic procedures

Abstract

Background: Endoscopic submucosal dissection (ESD) and peroral endoscopic myotomy (POEM) are recently developed techniques that have the potential to significantly improve clinical outcomes. However, training opportunities on these techniques remain limited. To address this issue, we developed a novel ex-vivo ESD/POEM training model. Our aim in this paper is to describe the model and provide preliminary evidence of promising feasibility to improve access to ESD/POEM training. Methods:The model was developed using polyvinyl alcohol hydrogel, which can easily be modified to reproduce the stiffness of the different intestinal layers, namely the mucosa, submucosa, and muscle layer.Results: A training workshop, using our ex-vivo model, was held for 28 residents. Satisfaction and feasibility in using the ex-vivo model for endoscopic training were evaluated by using a self-report questionnaire. All participants were satisfied with their training experience (100% satisfaction rate), with 27 of the 28 participants reporting that the model was feasible in replicating all components of the ESD/POEM technique (96.4% feasibility rate).Conclusions: Based on this feedback, we propose that our non-biomaterial model has the feasibility to provide an effective endoscopy education tool and a satisfactory training experience.

Development of new gastric endoscopic submucosal dissection training model: A reproducibility evaluation study

“…Thus, we considered that this model could duplicate the actual gastric ESD in terms of the procedure speed in each location. Sato et al and Chen et al have reported the feasibility of ESD training models using non-animal subjects 9 10 . The model that uses non-animal subjects can be trained to be effective for ESD in any facility equipped for endoscopy, without requiring endoscopic units specialized for animal use.…”

“…Presence of the muscle layer also allows ESD training to be performed with caution with respect to muscle layer damage and perforation during submucosal dissection. This setting frame enables ESD in various lesion ▶ ▪ Dissection time 11 (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) sites in the stomach by adjusting the angle of the seat position, distance between the cardia and the seat, angle of the cardia, and a spatula that imitates the greater curvature of the stomach. Therefore, the feeling of the scope's movement for each location is reproduced, and this makes it possible to be used for training while considering ESD strategies for each location.…”

Simulator-based training method in gastrointestinal endoscopy training and currently available simulators

“…The satisfaction rate was 100%, and the feasibility rate was 96.4%, indicating that EndoGel may be an effective endoscopy education tool. 59 …”

A Newly Designed Polyvinyl Alcohol Hydrogel-Based Gastric ESD Simulator for Trainees: A Pilot Study

“…Recently, a new arti cial ESD simulator, Endogel (Sunarrow, Japan), was developed for ESD/ Peroral Endoscopic Myotomy (POEM) training [7,10]. Endogel is a composite plate laminated with three different types of polyvinyl alcohol hydrogel (PVA-H) sheets.…”

“…Different types of PVA-H sheets can be laminated with different elasticity. It is possible to simulate procedures such as mucosal incision, submucosal dissection, and muscle layer myotomy with PVA-H sheets mimicking the mucosa and submucosa [10]. However, there are some limitations to the Endogel.…”