Vázquez-Sequeiros E, de Miquel D Boixeda, Olcina J R Foruny, Martín J A González, García M, Lucas D Juzgado, Garrido E, González C, Blanco A Parra, Arnau M R, Buenadicha A, Vicente V Moreira, de Argila C Martín, Milicua J M
Service of Gastroenterology, University Hospital Ramón y Cajal, Madrid, Spain.
Rev Esp Enferm Dig. 2009 Aug;101(8):546-52. doi: 10.4321/s1130-01082009000800005.
The elevated risk of complications and technical complexity of endoscopic submucosal dissection (ESD) has limited its implementation in our medical system.
To design and evaluate a training program for learning the ESD technique.
Four endoscopists with no experience with ESD underwent a 4-step training program: 1) review of the existing literature, didactic material, and theoretical aspects of ESD; 2) ESD training in an ex-vivo animal model; 3) ESD training in an in-vivo animal model (supervised by ESD expert); and 4) ESD performance in a patient. A standard gastroscope and an ESD knife (IT, Flex or Hook-knife Olympus) were employed. The classical ESD technique was performed: rising of the lesion, circumferential incision, and submucosal dissection.
Ex-vivo animal model: 6 x swine stomach/esophagus -cost < 100 euro; 6 x ESD: antrum (n = 2), body (n = 3) and fundus/cardia (n = 1)-; size of resected specimen: 4-10 cm; ESD duration: 105-240 minutes; therapeutic success: 100%; complications: perforation (1/6: 16%) sealed with clips. In-vivo animal model: 6 ESD (antrum/body of stomach: 4; esophagus: 2); size: 2-5 cm; duration: 40-165 minutes; success: 100%; complications: 0%.
ESD of a gastric lesion located in the antrum/body; size: 3 cm; duration 210 minutes; a complete resection was achieved; no complications.
The results of the present study support the usefulness of this model for learning ESD in our system.
内镜黏膜下剥离术（ESD）并发症风险较高且技术复杂，这限制了其在我们医疗系统中的应用。
设计并评估一项用于学习ESD技术的培训项目。
四名无ESD经验的内镜医师接受了一个四步骤培训项目：1）复习ESD的现有文献、教学资料和理论知识；2）在离体动物模型上进行ESD培训；3）在活体动物模型上进行ESD培训（由ESD专家指导）；4）在患者身上进行ESD操作。使用标准胃镜和ESD刀（奥林巴斯IT刀、Flex刀或Hook刀）。采用经典的ESD技术：提起病变、环形切开和黏膜下剥离。
离体动物模型：6个猪胃/食管——成本<100欧元；6次ESD：胃窦（n = 2）、胃体（n = 3）和胃底/贲门（n = 1）；切除标本大小：4 - 10厘米；ESD持续时间：105 - 240分钟；治疗成功率：100%；并发症：穿孔（1/6：16%），用夹子封闭。活体动物模型：6次ESD（胃窦/胃体：4例；食管：2例）；大小：2 - 5厘米；持续时间：40 - 165分钟；成功率：100%；并发症：0%。
对位于胃窦/胃体的胃部病变进行ESD；大小：3厘米；持续时间210分钟；实现了完整切除；无并发症。
本研究结果支持该模型在我们系统中用于学习ESD的实用性。
