Difficulties and outcomes in starting endoscopic submucosal dissection

Area of Science:

• Gastroenterology
• Surgical Education
• Medical Simulation

Background:

• Endoscopic submucosal dissection (ESD) is a complex endoscopic procedure.
• ESD carries a significant risk of complications, particularly for novice practitioners.
• Assessing the learning curve and challenges in ESD is crucial for improving training.

Purpose of the Study:

• To evaluate the difficulties and outcomes for endoscopists learning endoscopic submucosal dissection (ESD).
• To assess the effectiveness of a porcine model for ESD training.
• To identify factors influencing complication rates during ESD learning.

Main Methods:

• Prospective study of endoscopists in an ESD training workshop.
• Participants used a porcine model for gastric and esophageal ESD.
• Data collected on knife usability, complications, procedure time, and outcomes.

Main Results:

• 24 endoscopists trained in gastric and esophageal ESD.
• High complication rates observed: 65.22% perforation and 56.52% bleeding during gastric ESD.
• Non-insulated knives were associated with a higher perforation risk.
• Porcine model deemed appropriate for simulating human ESD procedures (96%).

Conclusions:

• Endoscopic submucosal dissection (ESD) is technically demanding for beginners, with frequent complications.
• Non-insulated knives may increase perforation risk during the initial learning phase of gastric ESD.
• Training models can aid skill acquisition in lower-volume settings but do not replace patient-based training.