Experimental gastric endoscopic submucosal dissection: training in a porcine model

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

doi:10.20524/aog.2017.0147

Cited by 6 publications

(9 citation statements)

References 22 publications

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“…Lastly, up to date, compared with the quantity of clinical research, data on ESD from animal study is limited. ESD on living piglets have been reported in the application of endoscopists training and evaluation the new techniques ( 61 , 62 ). Taking the advantages of animal experiments, porcine model will be a useful tool in establishment of training standards and exploring technical innovations for ESD in the future.…”

Section: Discussionmentioning

confidence: 99%

Studies on endoscopic submucosal dissection in the past 15 years: A bibliometric analysis

Jia²,

Zhou³

et al. 2022

Front. Public Health

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Background and aimsEndoscopic submucosal dissection (ESD) is an advanced minimally invasive technique for en bloc resection of superficial gastrointestinal lesions, which is drawn an increasing attention from its emergence. This bibliometric analysis is to evaluate the origin, current hotspots, and research trends on ESD.MethodsA total of 2,131 publications on ESD from 2006 to 2020 were obtained from the Web of Science Core Collection (WoSCC) database. Bibliometric visualization analyses of countries/regions, institutes, authors, journals, references and keywords were performed by CiteSpace V.5.8.R3.ResultsThe quantity of publications on ESD increased significantly during the past 15 years. Japan occupied the leading position in terms of research power. Professor Yutaka Saito, together with the institute he belongs, the Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan, were the most productive author and institute, respectively. Colorectal ESD led the main thematic concentrations in ESD research. The most prolific journal was Gastrointestinal Endoscopy. European ESD Guideline was the most frequently co-cited reference. Guideline, meta-analysis, endoscopic resection, poly-glycolic acid sheet, Barrett's esophagus, fibrin glue, risk and colorectal neoplasm will be the active research hotspots in the future.ConclusionsThese findings provide the trends and frontiers in the field of ESD, as well as valuable information for clinicians and scientists to discover the future perspectives with potential collaborators.

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Section: Discussionmentioning

confidence: 99%

Studies on endoscopic submucosal dissection in the past 15 years: A bibliometric analysis

Jia²,

Zhou³

et al. 2022

Front. Public Health

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“…Several researchers recommend practice on live animal models, in which the procedural steps of ESD and the management of complications, including bleeding and perforation, can be imitated before practicing on humans. [11][12][13][14] However, live animal models have some limitations due to requirements for veterinarians, expensive instruments, special facilities, and consideration of ethical principles. The ex vivo model is advantageous in terms of cost and convenience for training.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, some authors have demonstrated the efficacy of using live animal models for gastric ESD training. 11,19,20 Although the efficacy of using ex vivo models for ESD training in the esophagus or colorectum has been reported, there are no reports on the efficacy or benefits of using the ex vivo model for live animal models or human gastric ESD training. 21,22 Because of the limitations of the training on ex vivo or live animal models before practicing on human cases.…”

Section: Discussionmentioning

confidence: 99%

Is Ex Vivo Training before In Vivo Training Effective in Learning Gastric Endoscopic Submucosal Dissection?

Pih

Lee

Ahn

et al. 2021

Korean J Helicobacter Up Gastrointest Res

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Background/Aims: The learning curve is essential in endoscopic submucosal dissection (ESD) training to improve outcomes and reduce the risk of procedure-related complications. We compared the outcomes of gastric ESD in live pigs performed by inexperienced endoscopists with or without ex vivo training.Materials and Methods: At the Olympus Medical Training and Education Center, nine endoscopists inexperienced in ESD were randomly divided into two groups (group A: ex vivo training followed by in vivo training; group B: in vivo training only), and they performed gastric ESDs.Results: A total of 18 ESDs were performed. The en bloc resection rate was 88.9% (16/18), and the complete resection rate was 94.4% (17/18). The median specimen size was 2.5 cm in group A and 2.1 cm in group B (P=0.227). There was no significant difference in the procedure time between the two groups, except for the marking time (0′58″ vs. 2′58″, P=0.027). However, group A took a shorter time in dissecting the same area than group B (109 vs. 246 sec/cm2, P=0.083). Complication rates were not significantly different between both groups.Conclusions: The procedure time during in vivo ESD training in pigs may be shortened by prior ex vivo training. However, the ex vivo model presented poor air inflation, unstable fixation, and excessive mucosal hardness for cutting. An advanced simulator or sufficient ex vivo training may be effective in training for the ESD procedure.

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“…The number of adverse events decreased as performance and speed improved during the learning phase. ESD speed in live models varies between studies from means of 5-10 mm 2 /min [35] in the first procedures to 22-30 mm 2 /min [21,22] in the later ones. This is in line with our results that varied from median 8.6 mm 2 /min in the first procedure to 24.7 mm 2 /min and 31.4 mm 2 /min in the last ones.…”

Section: Discussionmentioning

confidence: 99%

A Steep Early Learning Curve for Endoscopic Submucosal Dissection in the Live Porcine Model

Küttner-Magalhães

Dinis‐Ribeiro

Bruno

et al. 2021

Dig Dis

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Background: Endoscopic Submucosal Dissection (ESD) is a demanding procedure requiring high level of expertise. ESD training programs incorporate procedures with live animal models. This study aimed to assess the early learning curve for performing ESD on live porcine models by endoscopists without any or limited previous ESD experience. Methods: In a live porcine model ESD workshop, number of resections, completeness of the resections, en bloc resections, adverse events, tutor intervention, type of knife, ESD time and size of resected specimens were recorded. ESD speed was calculated. Results: A total of 70 procedures were carried out by 17 trainees. The percentage of complete resections, en bloc resections and ESD speed increased from the first to the latest procedures (88,2% to 100%; 76,5% to 100%; 8,6 to 31,4mm2/min, respectively). The number of procedures in which a trainee needed tutor intervention and the number of adverse events also decreased throughout the procedures (4 to 0 and 6 to 0, respectively). During the workshop, when participants changed to a different type of knife, ESD speed slightly decreased (18,5mm2/min to 17,0mm2/min) and adverse events increased again (0 to 2). Conclusions: Through successive procedures, complete resections, en bloc resections and ESD speed improve whereas adverse events decrease, supporting the role of the live porcine model in the preclinical learning phase. Changing ESD knives has a momentarily negative impact on the learning curve.

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Experimental gastric endoscopic submucosal dissection: training in a porcine model

Cited by 6 publications

References 22 publications

Studies on endoscopic submucosal dissection in the past 15 years: A bibliometric analysis

Studies on endoscopic submucosal dissection in the past 15 years: A bibliometric analysis

Is Ex Vivo Training before In Vivo Training Effective in Learning Gastric Endoscopic Submucosal Dissection?

A Steep Early Learning Curve for Endoscopic Submucosal Dissection in the Live Porcine Model

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