Endoscopic Pattern Tracing and Inanimate ex-vivo Pig Stomach Models to Acquire Skills Necessary for Endoscopic Submucosal Dissection (ESD)

By Richard Whelan 6 Videos FEATURING Richard Whelan

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January 2, 2019

Introduction: In Japan ESD is the gold standard treatment for large sessile adenomas and superficial ...
read more ↘ cancers. In the US these lesions are usually treated via colectomy that is more costly and morbid. During ESD, to cut the mucosa and the polyps submucosal attachments, the scope tip must be moved with a hot needle knife protruding in a controlled and coordinated manner. Most Western MD’s do not have this skill (polypectomy and biopsy are done with scope in stationary position). This video presents 2 inanimate training models the goal of which is improvement of scope tip skills.

Method: The “colon” is a hollow plastic tube affixed to a flat board with a window cut out and a sponge with a slit (anus) at one end. In the Pattern Tracing Model pieces of paper with line figures (circle, S, 8, & grid patterns) are placed over the window; the figures are traced using a modified sclerotherapy catheter that serves a “pen”. The tracings are scored for time, accuracy and number of pen strokes. In the ex vivo Pig Stomach Model a piece of pig stomach with a tattooed “polyp” and overlying bovey pad is placed over the window and an ESD performed after submucosal lift using a needle knife. The accuracy and efficiency of each ESD is scored (time, margins, number lift injections, deep wall injuries, etc).

Results/Conclusion: Preliminary results concerning 26 pattern tracing and 30 ESD sessions are given and suggest that the use of these models improve scope control skills.

Summary: Endoscopic Submucosal Dissection (ESD) allows for colonoscopic en bloc excision of large sessile adenomas which eliminates the need for colectomy. Presently, most American surgeons and GI MDs do not have the skill set necessary to perform ESD. Two inanimate models that allow trainees to learn colonoscopic skills that are needed for ESD removal of large sessile adenomas are presented and explained. Successful completion of the pattern tracing and pig stomach model exercises requires the endoscopist to control the scope tip while it is moved with an activated needle knife protruding. It is believed that these models will improve skills.
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Endoscopic Pattern Tracing and Inanimate ex-vivo Pig Stomach Models to Acquire Skills Necessary for Endoscopic Submucosal Dissection (ESD)

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