Usefulness of training using animal models for colorectal endoscopic submucosal dissection: is experience performing gastric ESD really needed?

Abstract

Background and study aims: Despite the clinical advantages of colorectal endoscopic submucosal dissection (ESD), an effective training system, especially for Western endoscopists, has been challenging to establish. Herein, we propose a novel training program using ex vivo animal models and evaluate the learning curve of colorectal ESD trainees without gastric ESD experience. Patients and methods: A total of 80 colorectal lesions were prospectively collected and removed by two novice operators. Before human ESD procedures, they received ESD training using an ex vivo porcine “proximal colon” model, which simulates a lumen with many folds and flexions. To assess the validity of our training system, the self-completion and en bloc R0 resection rates, the operation time, and prevalence of complications were compared between the first and latter period. Moreover the factors associated with prolonged operation time were evaluated. Results: The overall rates of self-completion and en bloc R0 resection were 98 % (78/80) and 100 % (80/80), respectively. The operation time during the first period was significantly longer than that during the latter period (86 ± 50 minutes vs. 60 ± 36 minutes, P = 0.01). Regarding complications, only two cases of perforations and delayed hemorrhage were observed during the first period; however, all of the complications were successfully managed endoscopically. The presence of fibrosis was identified as a significant independent predictor of a prolonged operation time during the first period (coefficient, 5.90; 95 %CI, 2.36 – 9.44, P = 0.002). Conclusions: Our trainees achieved high rates of self-completion and R0 resection without severe complications even during the first 20 cases, suggesting that our training programs using ex vivo animal models are useful for trainees without gastric ESD experience.Study registration: UMIN000013566

Feasibility of colorectal endoscopic submucosal dissection (ESD) carried out by endoscopists with no or little experience in gastric ESD

“…As Ohata et al . have emphasized, supervision by experts might contribute to the present better results.…”

“…Ohata et al . described the usefulness of an ex vivo porcine proximal colon model, in which the rectum suitable for training is upended so that it is placed on the proximal colon side . This model contributed to reduced time for becoming proficient in colorectal ESD even without experience in gastric ESD.…”

Experimental gastric endoscopic submucosal dissection: training in a porcine model

“…ESD was developed in Japan in 1999 for the endoscopic removal of early gastric cancers [1]. Today, its use has spread worldwide.…”

“…Despite the growing number of ESD-related publications in both asian and western countries, there is only limited evidence regarding the efficacy and value of training by means of in vivo ESD workshops [1,5,7,8]. …”

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

“…Presently, training methods for endoscopic procedures use live animals or extracted animal intestines (5,6). The many barriers related to the use of animals for education have, therefore, limited the availability of endoscopic training workshops.…”