Skip to main content
SpringerLink
Log in

Ex vivo pig training model for esophageal endosopic submucosal dissection (ESD) for endoscopists with experience in gastric ESD

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Esophageal endoscopic submucosal dissection (ESD) has developed in recent years because of its high rate of en bloc resection. However, for many endoscopists, technical difficulty and risks of complications are great barriers to performing esophageal ESD. In this study, we developed an original training model for esophageal ESD using isolated pig esophagus and assessed this ex vivo model in endoscopists with experience in gastric ESD.

Methods

Three endoscopists without experience in esophageal ESD but with some experience in gastric ESD performed esophageal ESD of artificial lesions in 10 consecutive sessions using this ex vivo model. The en bloc resection rate, operation time, number of muscularis propria layer injuries, and presence of perforation were recorded. We evaluated the effectiveness of this training in the three endoscopists by comparing results from the first five sessions (former period) with those from the last five sessions (latter period).

Results

All three endoscopists achieved en bloc resections in all trials. In the former period, injury to the muscularis propria layer for each of the three endoscopists occurred a mean of 2.2 (1–3), 0.6 (0–1), and 3.2 (1–6) times, respectively. Perforation occurred in one session performed by one endoscopist. In the latter period, the mean number of muscularis propria layer injuries for each of the three endoscopists decreased to 0.2 (0–1), 0.2 (0–1), and 0.8 (0–2), respectively. The time of operation shortened from 35.0 (25–40), 36.4 (30–50), and 29.8 (23–43) min to 23.0 (16–31), 25.6 (23–28), and 29.2 (21–37) min, respectively.

Conclusions

This original ex vivo training model was helpful to endoscopists with experience in gastric ESD in acquiring the basic skills for performing esophageal ESD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Muto M, Minashi K, Yano T, Saito Y, Oda I, Nonaka S, Omori T, Sugiura H, Goda K, Kaise M, Inoue H, Ishikawa H, Ochiai A, Shimoda T, Watanabe H, Tajiri H, Saito D (2010) Early detection of superficial squamous cell carcinoma in the head and neck region and esophagus by narrow band imaging: a multicenter randomized controlled trial. J Clin Oncol 2:1566–1572

    Article  Google Scholar 

  2. Kuraoka K, Hoshino E, Tsuchida T, Fujisaki J, Takahashi H, Fujita R (2009) Early esophageal cancer can be detected by screening endoscopy assisted with narrow-band imaging (NBI). Hepatogastroenterology 56:63–66

    PubMed  Google Scholar 

  3. Makuuchi H (1996) Endoscopic mucosal resection for early esophageal cancer. Indication and techniques. Dig Endosc 8:175–179

    Google Scholar 

  4. Kato H, Tachimori Y, Mizobuchi S, Igaki H, Ochiai A (1993) Cervical, mediastinal, and abdominal lymph node dissection (three-field dissection) for superficial carcinoma of the thoracic esophagus. Cancer 72:2879–2882

    Article  PubMed  CAS  Google Scholar 

  5. Kato H, Tachimori Y, Watanabe H, Yamaguchi H, Ishikawa T, Itabashi M (1990) Superficial esophageal carcinoma. Surgical treatment and the results. Cancer 66:2319–2323

    Article  PubMed  CAS  Google Scholar 

  6. Roth JA, Putnam JB Jr (1994) Surgery for cancer of the esophagus. Semin Oncol 21:453–461

    PubMed  CAS  Google Scholar 

  7. Ciocirlan M, Lapalus MG, Hervieu V, Souquet JC, Napoléon B, Scoazec JY, Lefort C, Saurin JC, Ponchon T (2007) Endoscopic mucosal resection for squamous premalignant and early malignant lesions of the esophagus. Endoscopy 39:24–29

    Article  PubMed  CAS  Google Scholar 

  8. Pech O, Gossner L, May A, Vieth M, Stolte M, Ell C (2004) Endoscopic resection of superficial esophageal squamous-cell carcinomas: western experience. Am J Gastroenterol 99:1226–1232

    Article  PubMed  Google Scholar 

  9. Higuchi K, Tanabe S, Koizumi W, Sasaki T, Nakatani K, Saigenji K, Kobayashi N, Mitomi H (2007) Expansion of the indications for endoscopic mucosal resection in patients with superficial esophageal carcinoma. Endoscopy 39:36–40

    Article  PubMed  CAS  Google Scholar 

  10. Tajima Y, Nakanishi Y, Ochiai A, Tachimori Y, Kato H, Watanabe H, Yamaguchi H, Yoshimura K, Kusano M, Shimoda T (2000) Histopathologic findings predicting lymph node metastasis and prognosis of patients with superficial esophageal carcinoma: analysis of 240 surgically resected tumors. Cancer 88:1285–1293

    Article  PubMed  CAS  Google Scholar 

  11. Ishihara R, Iishi H, Uedo N, Takeuchi Y, Yamamoto S, Yamada T, Masuda E, Higashino K, Kato M, Narahara H, Tatsuta M (2008) Comparison of EMR and endoscopic submucosal dissection for en bloc resection of early esophageal cancers in Japan. Gastrointest Endosc 68:1066–1072

    Article  PubMed  Google Scholar 

  12. Pech O, May A, Gossner L, Rabenstein T, Manner H, Huijsmans J, Vieth M, Stolte M, Berres M, Ell C (2007) Curative endoscopic therapy in patients with early esophageal squamous-cell carcinoma or high-grade intraepithelial neoplasia. Endoscopy 39(1):30–35

    Article  PubMed  CAS  Google Scholar 

  13. Katada C, Muto M, Manabe T, Ohtsu A, Yoshida S (2005) Local recurrence of squamous-cell carcinoma of the esophagus after EMR. Gastrointest Endosc 6:219–225

    Article  Google Scholar 

  14. Esaki M, Matsumoto T, Hirakawa K, Nakamura S, Umeno J, Koga H, Yao T, Iida M (2007) Risk factors for local recurrence of superficial esophageal cancer after treatment by endoscopic mucosal resection. Endoscopy 39:41–45

    Article  PubMed  CAS  Google Scholar 

  15. Ishihara R, Iishi H, Takeuchi Y, Kato M, Yamamoto S, Yamamoto S, Masuda E, Tatsumi K, Higashino K, Uedo N, Tatsuta M (2008) Local recurrence of large squamous-cell carcinoma of the esophagus after endoscopic resection. Gastrointest Endosc 67:799–804

    Article  PubMed  Google Scholar 

  16. Kakushima N, Fujishiro M (2008) Endoscopic submucosal dissection for gastrointestinal neoplasms. World J Gastroenterol 14:2962–2967

    Article  PubMed  Google Scholar 

  17. Ono H, Kondo H, Gotoda T, Shirao K, Yamaguchi H, Saito D, Hosokawa K, Shimoda T, Yoshida S (2001) Endoscopic mucosal resection for treatment of early gastric cancer. Gut 48:225–229

    Article  PubMed  CAS  Google Scholar 

  18. Takeuchi Y, Uedo N, Iishi H, Yamamoto S, Yamamoto S, Yamada T, Higashino K, Ishihara R, Tatsuta M, Ishiguro S (2007) Endoscopic submucosal dissection with insulated-tip knife for large mucosal early gastric cancer: a feasibility study (with videos). Gastrointest Endosc 66:186–193

    Article  PubMed  Google Scholar 

  19. Isomoto H, Shikuwa S, Yamaguchi N, Fukuda E, Ikeda K, Nishiyama H, Ohnita K, Mizuta Y, Shiozawa J, Kohno S (2009) Endoscopic submucosal dissection for early gastric cancer: a large-scale feasibility study. Gut 58:331–336

    Article  PubMed  CAS  Google Scholar 

  20. Oyama T, Tomori A, Hotta K, Morita S, Kominato K, Tanaka M, Miyata Y (2005) Endoscopic submucosal dissection of early esophageal cancer. Clin Gastroenterol Hepatol 3:67–70

    Article  Google Scholar 

  21. Fujishiro M, Yahagi N, Kakushima N, Kodashima S, Muraki Y, Kawabe T, Ichinose M, Omata M (2006) Endoscopic submucosal dissection of esophageal squamous cell neoplasms. Clin Gastroenterol Hepatol 4:688–694

    Article  PubMed  Google Scholar 

  22. Ishii N, Horiki N, Itoh T, Uemura M, Maruyama M, Suzuki S, Uchida S, Izuka Y, Fukuda K, Fujita Y (2009) Endoscopic submucosal dissection with a combination of small-caliber-tip transparent hood and flex knife is safe and effective treatment for superficial esophageal neoplasias. Surg Endosc 24:335–342

    Article  PubMed  Google Scholar 

  23. Ono S, Fujishiro M, Niimi K, Goto O, Kodashima S, Yamauchi N, Omata M (2009) Long-term outcomes of endoscopic submucosal dissection for superficial esophageal squamous cell carcinomas. Gastrointest Endosc 70:860–866

    Article  PubMed  Google Scholar 

  24. Inoue H, Minami H, Kaga M, Sato Y, Kudo SE (2010) Endoscopic mucosal resection and endoscopic submucosal dissection for esophageal dysplasia and carcinoma. Gastrointest Endosc Clin North Am 20:25–34

    Article  Google Scholar 

  25. Repici A, Hassan C, Carlino A, Pagano N, Zullo A, Rando G, Strangio G, Romeo F, Nicita R, Rosati R, Malesci A (2010) Endoscopic submucosal dissection in patients with early esophageal squamous cell carcinoma: results from a prospective Western series. Gastrointest Endosc 71:715–721

    Article  PubMed  Google Scholar 

  26. Parra-Blanco A, Arnau MR, Nicolás-Pérez D, Gimeno-García AZ, González N, Díaz-Acosta JA, Jiménez A, Quintero E (2010) Endoscopic submucosal dissection training with pig models in a Western country. World J Gastroenterol 16:2895–2900

    Article  PubMed  Google Scholar 

  27. Tanimoto MA, Torres-Villalobos G, Fujita R, Santillan-Doherty P, Albores-Saavedra J, Gutierrez G, Martin-del-Campo LA, Bravo-Reyna C, Villanueva O, Villalobos JJ, Uribe M, Valdovinos MA (2010) Endoscopic submucosal dissection in dogs in a World Gastroenterology Organisation training center. World J Gastroenterol 16:1759–1764

    Article  PubMed  Google Scholar 

  28. Vázquez-Sequeiros E, de Miquel DB, Olcina JR, Martín JA, García M, Lucas DJ, Garrido E, González C, Blanco AP, Arnau MR, Buenadicha A, Vicente VM, de Argila CM, Milicua JM (2009) Training model for teaching endoscopic submucosal dissection of gastric tumors. Rev Esp Enferm Dig 101:546–552

    PubMed  Google Scholar 

  29. Hon SS, Ng SS, Lee JF, Li JC, Lo AW (2010) In vitro porcine training model for colonic endoscopic submucosal dissection: an inexpensive and safe way to acquire a complex endoscopic technique. Surg Endosc 24:2439–2443

    Article  PubMed  Google Scholar 

Download references

Disclosures

Authors Shinwa Tanaka, Yoshinori Morita, Tsuyoshi Fujita, Chika Wakahara, Atsuki Ikeda, Takashi Toyonaga, and Takeshi Azuma have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, 7-5-1 Chu-o-ku, Kusunoki-Cho, Kobe, Hyogo, 650-0017, Japan

    Shinwa Tanaka, Yoshinori Morita, Tsuyoshi Fujita, Chika Wakahara, Atsuki Ikeda, Takashi Toyonaga & Takeshi Azuma

Authors
  1. Shinwa Tanaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yoshinori Morita
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tsuyoshi Fujita
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Chika Wakahara
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Atsuki Ikeda
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Takashi Toyonaga
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Takeshi Azuma
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shinwa Tanaka.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tanaka, S., Morita, Y., Fujita, T. et al. Ex vivo pig training model for esophageal endosopic submucosal dissection (ESD) for endoscopists with experience in gastric ESD. Surg Endosc 26, 1579–1586 (2012). https://doi.org/10.1007/s00464-011-2074-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-011-2074-6

Keywords

Search

Navigation