Endoscopic submucosal dissection training with pig models in a Western country

AIM:To test a strategy for endoscopic submucosal dissection(ESD) training in animal models designed to overcome the initial learning curve.METHODS: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.RESULTS:Complete resection was achieved in 28 cases(en bloc 27);2 could not be completed(one perforation,one technical diff iculty).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 signif icantly increased for the gastric cases performed in the f irst 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.CONCLUSION:Training in animal models could help endoscopists overcome the learning curve before starting ESD in humans.