International Journal of Healthcare Simulation

Background:

Endoscopic Submucosal Dissection (ESD) is a technique for removing lesions in the gastro-intestinal tract. It involves precise cutting into the submucosal layer, allowing for the lesion to be removed in one piece, and has been shown to have a high curative resection rate [1]. It is a technically challenging endoscopy technique that requires experience and practice. As one of the common complications from ESD is perforation [2], training on ex-vivo models is becoming popular with 84% of surveyed centres in the UK requiring Endoscopists to complete a number of ESDs on animal models before progressing to train on patients [3]. While training was accessible at other centres, this was infrequent and less accessible.

Methods:

Sessions were created at the hospital training centre. This was done using decommissioned endoscopy stacks and endoscopes, so that these were always available and designated for ex-vivo use only. The animal model was a porcine oesophagus, stomach, and start of duodenum prepared in a box with a hole for endoscope insertion. The duodenum was clamped to ensure inflation would be possible. The days ran from 0830-1530 with a drop-in option. After 7 sessions were run over 5 months, a survey was sent out to the 8 people that had participated to assess the benefits of the service (including faculty doing the training and trainees).

Results:

8 responses (100%) were collected. 62% (n=5) of responders had used ex-vivo models before. 83.3% of trainees (n=5) said they had come to our hospital specifically to train in ESD technique. Responders attended between 1 and 10 sessions at our centre. All trainees and faculty said they found the training extremely beneficial and that they thought the ex-vivo model work well the way it was set up. All responders said they would recommend the sessions to a colleague. All trainees said that training with an experienced Endoscopist was more beneficial than training alone. Suggestions for improvement included a more consistent timetable of when they could access sessions, more accessibility and wider range of endoscopy kit, and involving the wider nursing team in the sessions.

Conclusion:

The ex-vivo ESD training sessions were well received by both faculty and trainees and were said to be very beneficial to their training. We will therefore be putting on more of these sessions, taking into account the suggestion for a regular accessible timetable.

References

1. Ahmed Y, Othman M. EMR/ESD: techniques, complications, and evidence. Current Gastroenterology Reports. 2020;22(8):1–2.

2. Kim SG, Hwang JH. How to decrease the risk of perforation in endoscopic submucosal dissection (ESD). Techniques in Gastrointestinal Endoscopy. 2019;21(2):99–103.

3. Küttner-Magalhães R, Pimentel-Nunes P, Araújo-Martins M, Libânio D, Borges-Canha M, Marcos-Pinto R, Koch AD, Dinis-Ribeiro M. Endoscopic submucosal dissection (ESD): how do Western endoscopists value animal models?. Scandinavian Journal of Gastroenterology. 2021;56(4):492–7.