Portal de Periódicos da CAPES

Training model for teaching endoscopic submucosal dissection of gastric tumors

2009; Arán Ediciones; Volume: 101; Issue: 8 Linguagem: Inglês

10.4321/s1130-01082009000800005

2340-4167

Enrique Vázquez-Sequeiros, D. Boixeda de Miquel, José Ramón Foruny Olcina, J. A. González Martín, Maria García-Gil, Diego Juzgado Lucas, Elena Azaola, Carlos R. Marín González, Adolfo Parra Blanco, M. R. Arnaa, A. López Buenadicha, Víctor Moreira Vicente, Carlos Martín de Argila, José Milicua,

Metastasis and carcinoma case studies

Introduction: the elevated risk of complications and technical complexity of endoscopic submucosal dissection (ESD) has limited its implementation in our medical system.Objective: to design and evaluate a training program for learning the ESD technique.Methods: four endoscopists with no experience with ESD underwent a 4-step training program: 1) review of the existing literature, didactic material, and theoretical aspects of ESD; 2) ESD training in an ex-vivo animal model; 3) ESD training in an in-vivo animal model (supervised by ESD expert); and 4) ESD performance in a patient.A standard gastroscope and an ESD knife (IT, Flex or Hook-knife Olympus ® ) were employed.The classical ESD technique was performed: rising of the lesion, circumferential incision, and submucosal dissection.Results: ex-vivo animal model: 6 x swine stomach/esophagus -cost < 100 euro; 6 x ESD: antrum (n = 2), body (n = 3) and fundus/cardia (n = 1)-; size of resected specimen: 4-10 cm; ESD duration: 105-240 minutes; therapeutic success: 100%; complications: perforation (1/6: 16%) sealed with clips.In-vivo animal model: 6 ESD (antrum/body of stomach: 4; esophagus: 2); size: 2-5 cm; duration: 40-165 minutes; success: 100%; complications: 0%.Patient: ESD of a gastric lesion located in the antrum/body; size: 3 cm; duration 210 minutes; a complete resection was achieved; no complications.Conclusions: the results of the present study support the usefulness of this model for learning ESD in our system.