Transferring Endoscopic Submucosal Dissection Skills From Hands-on to Human Cases

Transferring Endoscopic Submucosal Dissection Skills From Hands-on to Human Cases

Douglas K. Rex, MD, MASGE, reviewing Küttner Magalhães R, et al. Dig Dis 2021 Dec 2.

This report from The Netherlands describes the results of a survey of 118 participants in an endoscopic submucosal dissection (ESD) training workshop using live porcine models. There were 40 survey respondents (34%), of whom 19 (47%) performed human ESD after the workshop. 

Before clinical practice of ESD, all of the workshop participants trained with live animals and 68% with explants. Most started in the lower third of the stomach or rectum (90%) with lesions ≤30 mm in size (89%). Median ESD performance in humans over a mean of 3.9 years was 19 cases, with adverse events in <10% and R0 resection reported at 88%.

The course participants considered the training with live animals an essential prerequisite (89%). However, only 63% of participants considered explant experience essential, and the value of explant experience was rated lower than that with live animal models. 

Male participants were more likely than female participants to progress to human ESD (56.7% vs 20%, respectively). Most of those who advanced to ESD worked in academic or tertiary centers (79%). The most common reasons reported for not initiating human ESD were inadequate endoscopic unit resources (38%) and an insufficient number of human cases appropriate for ESD (24%).

Douglas K. Rex, MD, FASGE

COMMENT

This European experience of ESD training in live animal workshops is interesting and suggests a successful transition to human cases by a reasonable percentage but far from a complete set of participants.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

CITATION(S)

Küttner Magalhães R, Dinis-Ribeiro M, Marcos-Pinto R, Rolanda C, Koch AD. Endoscopic submucosal dissection (ESD) skills transfer to clinical practice after hands-on workshops: an international survey. Dig Dis 2021 Dec 2. (Epub ahead of print) (https://doi.org/10.1159/000521274)

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