Gastric endoscopic submucosal dissection: from animal model to patient

Abstract

Aim: To assess whether the use of porcine models is useful for learning endoscopic submucosal dissection (ESD), thus contributing to its subsequent application in human patients.

Methods: This study/learning process was carried out in 3 phases: Phase I: Ex vivo animal; Phase II: In vivo animal; Phase III: Humans. One endoscopist performed 30 gastric ESDs in porcine models, and later 5 gastric ESDs in 5 patients. The ESD was done following the method practiced at the National Cancer Center in Tokyo, Japan. Technical aspects, size, time and speed of ESD, as well as complications were registered. In patients, their clinical, endoscopic and histologic evolution was additionally added.

Results: Thirty en bloc ESDs were carried out in animal models. The mean ± SD size of the pieces was of 28.4 ± 1.2 mm, and the time of ESD was 41.7 ± 2.4 min. The time of ESD in the first 15 procedures was 43.0 ± 3.0 min whereas in the next 15 procedures, the time was 40.3 ± 3.9 min, P = 0.588. The speed in the first 15 ESDs was 1.25 ± 0.11 cm(2)/min vs 2.12 ± 0.36 cm(2)/min in the remaining 15, P = 0.028. There were no complications. In patients, 5 lesions were resected en bloc. The size of the pieces was 25.2 ± 5.1 mm and the time was 85.0 ± 25.6 min. Endoscopic and histological controls did not show evidence of residual neoplastic tissue.

Conclusion: A sequential ESD training program of a unique endoscopist, based on the practice in porcine models, contributed to learning ESD for its subsequent application in humans, yielding good results in efficacy and safety.

Keywords: Animal models; Endoscopic submucosal dissection; Porcine models; Training.

Figure 1

Plastic box with cadaveric model.

Figure 2

The stomachs were sutured with coated vicryl suture or prolene suture 3-0 without any insufflation inconvenience whatsoever in any of the cases. A: Open porcine stomach greater curvature; B: Porcine stomach sutured with vicryl.

Figure 3

Tattooing artificial lesion with methylene blue.

Figure 4

Endoscopic dissection speed (cm²/min) according endoscopic submucosal dissection group. Shows that the median rate in the first 15 dissections were placed in 1.28 cm²/min and in the second group was 1.89 cm²/min, showing an increase in the speed of dissection in the second group, P = 0.028.