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©2010 Baishideng. All rights reserved.
Endoscopic submucosal dissection training with pig models in a Western country
Adolfo Parra-Blanco, María Rosa Arnau, David Nicolás-Pérez, Antonio Z Gimeno-García, Nicolás González, Juan A Díaz-Acosta, Alejandro Jiménez, Enrique Quintero
Adolfo Parra-Blanco, David Nicolás-Pérez, Antonio Z Gimeno-García, Juan A Díaz-Acosta, Enrique Quintero, Department of Gastroenterology, University Hospital of the Canary Islands, Ofra s/n, La Laguna, 38320 Tenerife, Spain
Adolfo Parra-Blanco, Endoscopy Unit, Department of Gastroenterology, Asturias Central University Hospital, Celestino Villamil s/n, 33006 Oviedo, Spain
María Rosa Arnau, Research Animal Laboratory, Ofra s/n, La Laguna University, 38320 Tenerife, Spain
Nicolás González, Department of Gastroenterology, Montevideo Clinic Hospital, Avda Italia s/n, 11600 Montevideo, Uruguay
Alejandro Jiménez, Research Unit, University Hospital of the Canary Islands, Ofra s/n, La Laguna, 38320 Tenerife, Spain
Author contributions: Parra-Blanco A designed the research; Parra-Blanco A, Arnau MR, González N, Díaz-Acosta JA, Nicolás-Pérez D and Gimeno-García AZ performed the research; Parra-Blanco A, Jiménez A and Quintero E analyzed the data; Parra-Blanco A, Arnau MR and Quintero E drafted the manuscript; all authors read and approved the final manuscript.
Supported by (in part) A grant from Education, Culture and Sports Council, Government of the Canary Islands (“Consejería de Educación, Cultura y Deportes, Gobierno de Canarias”) (PI2002/138) and from the Health Institute Carlos III (“Instituto de Salud Carlos III”) (C03/02)
Correspondence to: Adolfo Parra-Blanco, MD, PhD, Head of the Endoscopy Unit, Department of Gastroenterology, Asturias Central University Hospital, Celestino Villamil s/n, 33006 Oviedo, Principado de Asturias, Spain. parrablanco@hotmail.com
Telephone: +34-985-108000 Fax: +34-985-108115
Received: August 22, 2009
Revised: January 7, 2010
Accepted: January 14, 2010
Published online: June 21, 2010
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 difficulty). 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 significantly increased for the gastric cases performed in the first 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.
