Department of Medicine I, Paracelsus Medical University/Salzburger Landeskliniken (SALK), Muellner Hauptstrasse 48, 5020 Salzburg, Austria.
Dig Endosc. 2011 Oct;23(4):281-9. doi: 10.1111/j.1443-1661.2011.01129.x. Epub 2011 Apr 7.
Endoscopic submucosal dissection (ESD) demands a new level of endoscopic skill in Europe. A 2-day workshop was set up for trainees to carry out five ESD each in order to obtain the skill level required to perform ESD in the stomach or rectum. This study describes: (i) the workshop setup; (ii) the participant's performance; and (iii) the training effect on post-workshop clinical ESD performance.
Eighteen very experienced European endoscopists participated in four half-day (4.5 h) training sessions, with everybody rotating daily through six separate training stations (two each with dual, hook, or hybrid knives) with expert tutors. One anesthetized piglet was used per station and session. After 1 year, the clinical ESD performance was surveyed to estimate the training effect of the workshop.
Overall, 74 ESD were performed, that is, 4.1 ESD per participant. On average ESD lasted 57 min for 6 cm(2) specimens. We detected a 22% rate of perforation (16 of 74 ESD with perforations), mostly attributable to participants with less experience in ESD. Those who started clinical ESD within 1 year after the workshop performed 144 clinical ESD (median 8 [0-20] per trainee) mostly in the stomach (40%) and large bowel (46%) with an acceptable rate of perforation (9.7%) and surgical repair (3.5%) without mortality or persistent morbidity.
Intense skill training for ESD is needed to reduce the risk of perforation, as demonstrated by the results of this workshop. We show that experimental ESD training, however, enables skilled European endoscopists to perform ESD in standard locations with moderate risk of perforation during the clinical learning curve.
内镜黏膜下剥离术（ESD）在欧洲需要新的内镜技能水平。为此设立了为期两天的研讨会，培训学员进行五次 ESD，以获得在胃或直肠进行 ESD 所需的技能水平。本研究描述了：（i）研讨会的设置；（ii）参与者的表现；以及（iii）对术后临床 ESD 表现的培训效果。
18 名非常有经验的欧洲内镜医生参加了四个半天（4.5 小时）的培训课程，每个人每天轮流在六个单独的培训站（每个站各有两把双极刀、钩刀或混合刀）接受专家导师的培训。每个站和每个会议都使用一只麻醉小猪。一年后，对临床 ESD 表现进行调查，以评估研讨会的培训效果。
总共进行了 74 例 ESD，即每位参与者 4.1 例。平均 ESD 持续时间为 57 分钟，标本为 6cm²。我们检测到穿孔率为 22%（74 例 ESD 中有 16 例穿孔），主要归因于 ESD 经验较少的参与者。那些在研讨会结束后一年内开始进行临床 ESD 的医生共进行了 144 例临床 ESD（中位数 8 [0-20] 例/受训者），主要在胃（40%）和大肠（46%），穿孔率（9.7%）和手术修复（3.5%）可接受，无死亡或持续性并发症。
正如本研讨会的结果所示，需要进行密集的 ESD 技能培训，以降低穿孔风险。我们表明，实验性 ESD 培训使熟练的欧洲内镜医生能够在标准位置进行 ESD，在临床学习曲线中穿孔风险适中。
