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Dolan RD, Ryou M. Endoscopic simulators: training the next generation. Curr Opin Gastroenterol 2021; 37:589-595. [PMID: 34482322 DOI: 10.1097/mog.0000000000000788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
PURPOSE OF REVIEW To provide a review of current evidence evaluating endoscopic simulators as teaching platforms in gastroenterology training, with emphasis on upper gastrointestinal anatomy. RECENT FINDINGS Endoscopic simulators have leveraged mechanical, virtual reality and ex-vivo or live animal platforms to deliver training in both general and therapeutic endoscopy. Simulators have demonstrated their greatest utility in training novice endoscopists. Intermediate and expert endoscopists may additionally benefit from simulator exposure when learning advanced therapeutic techniques including large tissue resection or natural orifice transluminal endoscopic surgery. SUMMARY Simulator-based learning offers promise to complement conventional endoscopic training modalities for novice trainees. Nevertheless, additional evidence demonstrating a clear benefit is required for simulators to become an integral part of gastroenterology training. As novel advanced endoscopic therapies are developed, endoscopic simulators may assume a larger role in training prior to clinical practice.
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Affiliation(s)
- Russell D Dolan
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Pih GY, Lee JS, Ahn JY, Kim DH, Na HK, Lee JH, Jung KW, Choi KD, Song HJ, Lee GH, Jung HY. Is Ex Vivo Training before In Vivo Training Effective in Learning Gastric Endoscopic Submucosal Dissection? THE KOREAN JOURNAL OF HELICOBACTER AND UPPER GASTROINTESTINAL RESEARCH 2021. [DOI: 10.7704/kjhugr.2020.0064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Rajendran A, Pannick S, Thomas-Gibson S, Oke S, Anele C, Sevdalis N, Haycock A. Systematic literature review of learning curves for colorectal polyp resection techniques in lower gastrointestinal endoscopy. Colorectal Dis 2020; 22:1085-1100. [PMID: 31925890 DOI: 10.1111/codi.14960] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 11/26/2019] [Indexed: 02/08/2023]
Abstract
AIM The performance of therapeutic procedures in lower gastrointestinal endoscopy (LGI) can be challenging and carries an increased risk of adverse events. There is increasing demand for the training of endoscopists in these procedures, but limited guidelines exist concerning procedural competency. The aim of this study was to assess the learning curves for LGI polypectomy, colorectal endoscopic mucosal resection (EMR) and colorectal endoscopic submucosal dissection (ESD). METHOD A systematic review of electronic databases between 1946 and September 2019 was performed. Citations were included if they reported learning curve data. Outcome measures that defined the success of procedural competency were also recorded. RESULTS A total of 34 out of 598 studies met the inclusion criteria of which 28 were related to ESD, three to polypectomy and three to EMR. Outcome measures for polypectomy competency (en bloc resection, delayed bleeding and independent polypectomy rate) were achieved after completion of between 250 and 400 polypectomies and after 300 colonoscopies. EMR outcome measures, including complete resection and recurrence, were achieved variably between 50 and 300 procedures. Outcome measures for ESD included efficiency (resection rates and procedural speed) and safety (adverse events). En bloc resection rates of over 80% and R0 resection rates of over 70% were achieved at 20-40 cases and procedural speed increased after 30 ESD cases. Competency in safety metrics was variably achieved at 20-200 cases. CONCLUSION There is a paucity of data on learning curves in LGI polypectomy, EMR and ESD. Despite limited evidence, we have identified relevant outcome measures and threshold numbers for the most common LGI polyp resection techniques for potential inclusion in training programmes/credentialing guidelines.
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Affiliation(s)
- A Rajendran
- The Wolfson Unit for Endoscopy, St Mark's Hospital, Harrow, UK.,Centre for Implementation Science, Health Service and Population Research Department, King's College London, London, UK.,Hillingdon Hospitals NHS Foundation Trust, Uxbridge, UK
| | - S Pannick
- Department of Surgery and Cancer, Imperial College, London, UK
| | - S Thomas-Gibson
- The Wolfson Unit for Endoscopy, St Mark's Hospital, Harrow, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | - S Oke
- Hillingdon Hospitals NHS Foundation Trust, Uxbridge, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | - C Anele
- Department of Surgery and Cancer, Imperial College, London, UK
| | - N Sevdalis
- Centre for Implementation Science, Health Service and Population Research Department, King's College London, London, UK
| | - A Haycock
- The Wolfson Unit for Endoscopy, St Mark's Hospital, Harrow, UK.,Department of Surgery and Cancer, Imperial College, London, UK
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Jacques J, Legros R, Sautereau D. Mechanical model of sphincterotomy: a step forward for trainees. Endosc Int Open 2019; 7:E762-E763. [PMID: 31157799 PMCID: PMC6524996 DOI: 10.1055/a-0830-4712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Affiliation(s)
- Jérémie Jacques
- Gastroenterology and Endoscopy Unit, Dupuytren University Hospital, Limoges, France
- Bio-Em, Xlim, Limoges, France
| | - Romain Legros
- Gastroenterology and Endoscopy Unit, Dupuytren University Hospital, Limoges, France
| | - Denis Sautereau
- Gastroenterology and Endoscopy Unit, Dupuytren University Hospital, Limoges, France
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Chapelle N, Musquer N, Métivier-Cesbron E, Luet D, Volteau C, Le Rhun M, Coron E. Efficacy of a three-day training course in endoscopic submucosal dissection using a live porcine model: a prospective evaluation. United European Gastroenterol J 2018; 6:1410-1416. [PMID: 30386614 DOI: 10.1177/2050640618788694] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 06/18/2018] [Indexed: 12/12/2022] Open
Abstract
Background Endoscopic submucosal dissection is currently regarded as the method of choice for the resection of superficial tumours. The objective of our study was to evaluate prospectively the efficiency of an endoscopic submucosal dissection training course using live anaesthetised pigs. Methods Fourteen novice endoscopists participated in three gastric endoscopic submucosal dissection training courses on anaesthetised pigs. Each trainee resected five 'fake' antral lesions. Resected specimen sizes, endoscopic submucosal dissection speeds and the complication rate were evaluated prospectively. Results Among the 70 procedures performed, 58 could be analysed. There was a strong increase in endoscopic submucosal dissection speed (from 9.7 mm2/minute to 30.4 mm2/minute) during the sessions, marked between the first two endoscopic submucosal dissections compared with the fourth and fifth. There was a significant relation between the surface area of the resected lesion and procedure speed (P < 0.0001). The complication rate was 8.6%. Conclusion There is a clear benefit from endoscopic submucosal dissection training courses on animal models. Improved endoscopist capability is evident from the third endoscopic submucosal dissection. These data validate the indispensable nature of dedicated training courses and echo the European Society of Gastrointestinal Endoscopy proposition for multistep learning, beginning on animal models.
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Affiliation(s)
- Nicolas Chapelle
- CHU de Nantes, Hôtel-Dieu, Hépato-Gastroentérologie, Institut des Maladies de l'Appareil Digestif, Nantes, France
| | - Nicolas Musquer
- CHU de Nantes, Hôtel-Dieu, Hépato-Gastroentérologie, Institut des Maladies de l'Appareil Digestif, Nantes, France.,CEREDI, Faculté de médecine, Angers, France
| | - Elodie Métivier-Cesbron
- CEREDI, Faculté de médecine, Angers, France.,Service de gastro-entérologie, CHU Angers, Angers, France
| | - Dominique Luet
- CEREDI, Faculté de médecine, Angers, France.,Service de gastro-entérologie, CHU Angers, Angers, France
| | | | - Marc Le Rhun
- CHU de Nantes, Hôtel-Dieu, Hépato-Gastroentérologie, Institut des Maladies de l'Appareil Digestif, Nantes, France.,CEREDI, Faculté de médecine, Angers, France
| | - Emmanuel Coron
- CHU de Nantes, Hôtel-Dieu, Hépato-Gastroentérologie, Institut des Maladies de l'Appareil Digestif, Nantes, France.,CEREDI, Faculté de médecine, Angers, France.,Université de Nantes, INSERM, Institut des Maladies de l'Appareil Digestif, The enteric nervous system in gut and brain disorders, Nantes, France
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Schlachterman A, Yang D, Goddard A, Gotoda T, Draganov PV. Perspectives on endoscopic submucosal dissection training in the United States: a survey analysis. Endosc Int Open 2018; 6:E399-E409. [PMID: 29607391 PMCID: PMC5876020 DOI: 10.1055/s-0044-101452] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 01/03/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND STUDY AIMS Endoscopic submucosal dissection (ESD) is a widely accepted method for en-bloc resection of dysplastic lesions and early cancer in Asia and Europe. A limiting factor in adoption of ESD in the United States is perceived lack of training opportunities. The aims of this study were to: (1) evaluate ESD experience of attendees at a University-sponsored ESD training course; (2) characterize effectiveness of the current ESD training regimen and its impact on ESD adoption in the United States; and (3) gauge trainees' attitude towards ESD. PATIENTS AND METHODS An electronic anonymous survey was distributed to the 86 physicians who participated in the University of Florida's annual ESD course from 2014 to 2016. Main outcomes included participants' practice setting, prior training, current ESD techniques, and planned training. RESULTS A total of 34 participants (40 %) completed the survey. Most of the respondents routinely use one or more endoscopic mucosal resection (EMR) techniques (97.1 %) in their practice. Most respondents (79 %) had no experience with ESD on humans prior to the ESD course. Following completion of course training, more participants reported ongoing hands-on ESD exposure, with 15/34 (44 %) having performed ESD in humans. Most participants identified potential hurdles for adoption of ESD. CONCLUSION A dedicated ESD training course with hands-on experience, under the guidance of experts, notably increased use of ESD among participants. Limited availability of structured training opportunities, concerns over procedural length, lack of adequate number of lesions, and potential for serious adverse events (AEs) were identified as the main factors slowing adoption of ESD in the United States.
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Affiliation(s)
- Alexander Schlachterman
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Florida, Gainesville, Florida, United States
| | - Dennis Yang
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Florida, Gainesville, Florida, United States
| | - April Goddard
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Florida, Gainesville, Florida, United States
| | - Takuji Gotoda
- Division of Gastroenterology and Hepatology, Department of Medicine Nihon University School of Medicine, Tokyo, Japan
| | - Peter V. Draganov
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Florida, Gainesville, Florida, United States,Corresponding author Peter V. Draganov, MD Division of GastroenterologyUniversity of Florida1329 SW 16th Street, Suite 5251Gainesville, FL 32608+1-352-627-9002
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Jacques J, Legros R, Rivory J, Charissoux A, Sautereau D, Ponchon T, Pioche M. The "tunnel + clip" strategy standardised and facilitates oesophageal ESD procedures: a prospective, consecutive bi-centric study. Surg Endosc 2017; 31:4838-4847. [PMID: 28378087 DOI: 10.1007/s00464-017-5514-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 03/08/2017] [Indexed: 02/07/2023]
Abstract
INTRODUCTION ESD is the treatment of choice for superficial neoplasms of the oesophagus; ESD is oncologically efficient and associated with less morbidity than the surgical alternative. ESD requires a high level of skill, being both technically challenging and time consuming. Therefore, ESD is often reserved for experts. A combination of a tunnel technique with clip-line traction may enable optimisation of oesophageal ESD. PATIENTS AND METHODS From January 2015 to December 2016, we performed a prospective two-centre case study of consecutive "tunnel + clip" oesophageal ESD. Four young operators (each of whom had performed fewer than 50 ESDs and fewer than five oesophageal ESDs) treated patients requiring ESD using the tunnel + clip method. This involves generation of a classic tunnel beneath the lesion, with constant traction being applied by a clip with a line placed at the oral side of the tunnel. RESULTS Sixty-two lesions (25 SCCs and 34 ADK/HGDs complicating Barrett's oesophagus) were consecutively resected. The en bloc, R0, and curative resection rates were 100% (62/62), 88.7% (55/62), and 74.2% (46/62), respectively. No perforation was noted. The mean ESD velocity was 24.5 mm2/min for lesions of mean length 59.6 mm. The tunnel + clip approach greatly aided the procedure. No pathological damage caused by clipping was evident. CONCLUSION Use of the tunnel + clip strategy to treat oesophageal ESD is effective and safe, even when performed by physicians with little prior experience. It is thus possible to standardise ESD of superficial oesophageal neoplasms and increase the velocity of dissection. Our procedure will encourage the use of oesophageal ESD in Western countries.
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Affiliation(s)
- Jérémie Jacques
- Service d'hépato-gastro-entérologie, CHU Dupuytren, 2 avenue Martin Luther-King, 87042, Limoges, France.
| | - Romain Legros
- Service d'hépato-gastro-entérologie, CHU Dupuytren, 2 avenue Martin Luther-King, 87042, Limoges, France
| | - Jérome Rivory
- Service d'hépato-gastro-entérologie, Hôpital Edouard Herriot, Hospices civils de lyon, 5 place d'Arsonval, 69003, Lyon, France
| | - Aurélie Charissoux
- Service d'anatomopathologie, CHU Dupuytren, 2 avenue Martin Luther-King, 87042, Limoges, France
| | - Denis Sautereau
- Service d'hépato-gastro-entérologie, CHU Dupuytren, 2 avenue Martin Luther-King, 87042, Limoges, France
| | - Thierry Ponchon
- Service d'hépato-gastro-entérologie, Hôpital Edouard Herriot, Hospices civils de lyon, 5 place d'Arsonval, 69003, Lyon, France
| | - Mathieu Pioche
- Service d'hépato-gastro-entérologie, Hôpital Edouard Herriot, Hospices civils de lyon, 5 place d'Arsonval, 69003, Lyon, France
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