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Huang J, Du BR, Qiao WG, Huang SL, Xue LF, Deng L, Liang JM, Wang J, Li JY, Chen Y. Endoscopic submucosal dissection training: evaluation of an ex vivo training model with continuous perfusion (ETM-CP) for hands-on teaching and training in China. Surg Endosc 2023:10.1007/s00464-023-09940-9. [PMID: 36914780 DOI: 10.1007/s00464-023-09940-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 01/21/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND The existing ex vivo models of endoscopic submucosal dissection (ESD) cannot simulate intraoperative hemorrhage well. We aimed to establish an ESD training method by applying an ex vivo training model with continuous perfusion (ETM-CP). METHODS Four training sessions were conducted for 25 novices under the guidance of 2 experts. Eventually, 10 novices completed ESD operations on a total of 89 patients after the training. The resection effectiveness, resection speed, complication rate, and novice performance before and after the training were compared. The data regarding the effects of the training and the model were gathered through a questionnaire survey. RESULTS In terms of the simulation effect of the model, ETM-CP was evaluated as similar to the live pig in all aspects (P > 0.05). The questionnaire analysis revealed that the ESD theoretical knowledge, skill operation, and self-confidence of novices were improved after the training (P < 0.05). The resection time per unit area had a correlation with the number of training periods (rs = - 0.232). For novice performance, the resection time per unit area was shortened (P < 0.05). There was no difference in patient performance between the novice group and the expert group after the training in terms of en bloc resection, R0 resection, complication rate, endoscopic resection bleeding (ERB) score, muscularis propria injury (MPI) score, and resection time per unit area (P > 0.05). CONCLUSION The ETM-CP is effective for ESD training.
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Affiliation(s)
- Jun Huang
- Department of Gastroenterology, The Seventh Affiliated Hospital of Southern Medical University, No. 28, Liguan Road, Lishui Town, Nanhai District, Foshan, 528244, Guangdong, China
| | - Bing-Ran Du
- Department of Stomatology, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), Foshan, 528308, Guangdong, China
| | - Wei-Guang Qiao
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Si-Lin Huang
- Department of Gastroenterology, South China Hospital, Medical School, Shenzhen University, Shenzhen, 518116, China
| | - Lan-Feng Xue
- Department of Gastroenterology, The Seventh Affiliated Hospital of Southern Medical University, No. 28, Liguan Road, Lishui Town, Nanhai District, Foshan, 528244, Guangdong, China
| | - Liang Deng
- Department of Gastroenterology, LunJiao Hospital, Shunde District, Foshan, 528244, Guangdong, China
| | - Jun-Ming Liang
- Department of Gastroenterology, Xingtan Hospital Affiliated to Shunde Hospital of Southern Medical University, Foshan, 528325, China
| | - Jun Wang
- Department of Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Jian-Yi Li
- The Third Affiliated Hospital, Southern Medical University, Guangzhou, 510515, Guangdong, China.,Department of Anatomy, Guangdong Provincial Key Laboratory of Digital Medicine and Biomechanics, Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, School of Basic Medical Sciences, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Yu Chen
- Department of Gastroenterology, The Seventh Affiliated Hospital of Southern Medical University, No. 28, Liguan Road, Lishui Town, Nanhai District, Foshan, 528244, Guangdong, China.
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Walter B, Schmidbaur S, Krieger Y, Meining A. Improved endoscopic resection of large flat lesions and early cancers using an external additional working channel (AWC): a case series. Endosc Int Open 2019; 7:E298-E301. [PMID: 30746432 PMCID: PMC6368484 DOI: 10.1055/a-0824-6912] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 10/10/2018] [Indexed: 02/07/2023] Open
Abstract
Background En-bloc resection of large, flat lesions or early stages of cancer is challenging. No bimanual tasks are possible using standard endoscopes. Dual-channel endoscopes are not available everywhere and have a small distance between the channels. Patients and methods A new external additional working channel (AWC) (Ovesco, Tuebingen, Germany) was designed and developed potentially enabling bimanual tasks. Fixed to the tip of a standard gastroscope or pediatric colonoscope, a second endoscopic tool can be inserted through the AWC and used for tissue retraction during endoscopic resection. Results In the upper and lower gastrointestinal tract, endoscopic mucosal resection (EMR) with a modified grasp-and-snare technique and endoscopic submucosal dissection (ESD) were performed successfully using the AWC in eight patients. Complications were acute arterial bleeding post-EMR in two cases treated by endoscopic clipping. Conclusions We conclude that a newly developed external additional working channel (AWC) enables endoscopic resection of large lesions in the upper and lower gastrointestinal tract. Potential benefits are its suitability for EMR and ESD, no need for a dual-channel endoscope and an adjustable distance of working channels.
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Affiliation(s)
- Benjamin Walter
- Clinic for Internal Medicine I, Department of Gastroenterology, InExEn, University Hospital Ulm, Ulm, Germany,Corresponding author Dr. med. Benjamin M. Walter Uniklinik UlmKlinik für Innere Medizin IAlbert-Einstein-Allee 2389081 Ulm+0049 731/500 44502
| | - Simone Schmidbaur
- Clinic for Internal Medicine I, Department of Gastroenterology, InExEn, University Hospital Ulm, Ulm, Germany
| | - Yannick Krieger
- Institute of Microtechnology and Medical Device Technology, Technical University of Munich, Munich, Germany
| | - Alexander Meining
- Clinic for Internal Medicine I, Department of Gastroenterology, InExEn, University Hospital Ulm, Ulm, Germany
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Gallardo Cabrera VE, Hernández Mondragón O, Rascón Martínez DM, Blanco Velasco G, Ramos González R, Tun Abraham AE, Blancas Valencia JM. Disección endoscópica submucosa: curva de aprendizaje en modelos porcinos. ENDOSCOPIA 2015. [DOI: 10.1016/j.endomx.2015.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Tanimoto MA, Guerrero ML, Morita Y, Aguirre-Valadez J, Gomez E, Moctezuma-Velazquez C, Estradas-Trujillo JA, Valdovinos MA, Uscanga LF, Fujita R. Impact of formal training in endoscopic submucosal dissection for early gastrointestinal cancer: A systematic review and a meta-analysis. World J Gastrointest Endosc 2015; 7:417-428. [PMID: 25901222 PMCID: PMC4400632 DOI: 10.4253/wjge.v7.i4.417] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 02/09/2015] [Indexed: 02/05/2023] Open
Abstract
AIM: To summarize the clinical impact of a formal training for the effectiveness and safety of endoscopic submucosal dissection for gastrointestinal cancer.
METHODS: We searched databases including PubMed, EMBASE and the Cochrane Library and Science citation Index updated to August 2014 to include eligible articles. In the Meta-analysis, the main outcome measurements were en bloc resection rate, local recurrence rate (R0) and the incidence of procedure-related complications (perforation, bleeding).
RESULTS: En bloc resection was high for both, dissecting stomach tumors with an overall percentage of 93.2% (95%CI: 90.5-95.8) and dissecting colorectal tumors with an overall percentage of 89.4% (95%CI: 85.1-93.7). Although the number of studies reporting R0 resection (the dissected specimen was revealed free of tumor in both vertical and lateral margins) was small, the overall estimates for R0 resection were 81.4% (95%CI: 72-90.8) for stomach and 85.9% (95%CI: 77.5-95.5) for colorectal tumors, respectively. The analysis showed that the percentage of immediate perforation and bleeding were very low; 4.96 (95%CI: 3.6-6.3) and 1.4% (95%CI: 0.8-1.9) for colorectal tumors and 3.1% (95%CI: 2.0-4.1) and 4.8% (95%CI: 2.8-6.7) for stomach tumors, respectively.
CONCLUSION: In order to obtain the same rate of success of the analyzed studies it is a necessity to create training centers in the western countries during the “several years” of gastroenterology residence first only to teach EGC diagnose and second only to train endoscopic submucosal dissection.
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Coman RM, Gotoda T, Draganov PV. Training in endoscopic submucosal dissection. World J Gastrointest Endosc 2013; 5:369-378. [PMID: 23951392 PMCID: PMC3742702 DOI: 10.4253/wjge.v5.i8.369] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 04/26/2013] [Accepted: 06/19/2013] [Indexed: 02/05/2023] Open
Abstract
Endoscopic submucosal dissection (ESD) represents an important advancement in the therapy of early neoplastic gastrointestinal lesions by providing higher en-bloc curative resection rate with lower recurrence compared to endoscopic mucosal resection (EMR) and by sparing the involved organ and protecting patient’s quality of life. Despite these advantages ESD is associated with long procedure times and a higher rate of complications, making ESD a challenging procedure which requires advanced endoscopic skills. Thus, there has been a recognized need for structured training system for ESD to enhance trainee experience and, to reduce the risks of complications and inadequate treatment. ESD has a very flat learning curve. However, we do not have uniformly accepted benchmarks for competency. Nevertheless, it appears that, in Japan, more than 30 supervised gastric ESD procedures are required to achieve technical proficiency and minimize complications. A number of training algorithms have been proposed in Japan with the aim to standardize ESD training. These algorithms cannot be directly applied in the West due to substantial differences including the availability of highly qualified mentors, the type of pathology seen, choice of devices, and trainee’s background. We propose a training algorithm for Western physicians which integrates both hands-on training courses, animal model work as well as visits to expert centers. No specific preceptor training programs have been yet developed but there is a consensus that these programs are important for permeation of ESD worldwide.
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Abstract
Endoscopic submucosal dissection (ESD) represents an important advancement in the therapy of early neoplastic gastrointestinal lesions by providing higher en-bloc curative resection rate with lower recurrence compared to endoscopic mucosal resection (EMR) and by sparing the involved organ and protecting patient's quality of life. Despite these advantages ESD is associated with long procedure times and a higher rate of complications, making ESD a challenging procedure which requires advanced endoscopic skills. Thus, there has been a recognized need for structured training system for ESD to enhance trainee experience and, to reduce the risks of complications and inadequate treatment. ESD has a very flat learning curve. However, we do not have uniformly accepted benchmarks for competency. Nevertheless, it appears that, in Japan, more than 30 supervised gastric ESD procedures are required to achieve technical proficiency and minimize complications. A number of training algorithms have been proposed in Japan with the aim to standardize ESD training. These algorithms cannot be directly applied in the West due to substantial differences including the availability of highly qualified mentors, the type of pathology seen, choice of devices, and trainee's background. We propose a training algorithm for Western physicians which integrates both hands-on training courses, animal model work as well as visits to expert centers. No specific preceptor training programs have been yet developed but there is a consensus that these programs are important for permeation of ESD worldwide.
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Affiliation(s)
- Roxana M Coman
- Roxana M Coman, Peter V Draganov, Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Gainesville, FL 32610, United States
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