Department of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
Surg Endosc. 2013 Jan;27(1):154-61. doi: 10.1007/s00464-012-2402-5. Epub 2012 Jul 18.
Endoscopic submucosal dissection (ESD) has become a standard therapy for early gastric neoplasia, particularly in Asian countries. From a safety and efficacy standpoint, simulation training may empower the endoscopist to be able to learn the basic tenets of ESD in a safe, controlled and supervised setting before attempting first in humans.
This study was designed as a prospective ex vivo study. Ex vivo porcine organs were utilized in the EASIE-R endoscopic simulator. A total of 150 artificial lesions, each 2 × 2 cm in size, were created in fresh ex vivo porcine stomachs at six different anatomical sites (fundus anterior and posterior, body anterior and posterior, antrum anterior and posterior). Three examiners (2 beginners, 1 expert) participated in this study. All parameters (procedure time, specimen size, en-bloc resection status, perforation) were recorded by an independent observer for each procedure.
All 150 lesions were successfully resected using the ESD technique by the three endoscopists. After 30 ESD cases, the two novices performed ESD with a 100% en-bloc resection rate and without perforation. For the procedures performed by the novices, the total procedure time and perforation rate in the last 30 cases were significantly lower than during the first 30 cases (p < 0.05).
Our study suggests that performing 30 ESD resections in an ex vivo simulator leads to a significant improvement in safety and efficiency of performing the ESD technique.
内镜黏膜下剥离术（ESD）已成为治疗早期胃癌的标准疗法，尤其是在亚洲国家。从安全性和疗效的角度来看，模拟培训可以使内镜医生能够在尝试人体首例之前，在安全、可控和受监督的环境中学习 ESD 的基本原理。
本研究设计为前瞻性离体研究。离体猪器官用于 EASIE-R 内镜模拟器。在六个不同解剖部位（胃前、胃后、胃体前、胃体后、胃窦前、胃窦后）的新鲜离体猪胃中，共创建了 150 个人工病变，每个病变大小为 2×2cm。三位检查者（2 位初学者，1 位专家）参与了这项研究。所有参数（手术时间、标本大小、整块切除状态、穿孔）均由独立观察员记录。
三位内镜医生均成功地使用 ESD 技术切除了所有 150 个病变。在进行了 30 例 ESD 后，两位新手的 ESD 整块切除率达到 100%，没有穿孔。对于新手进行的手术，最后 30 例的总手术时间和穿孔率明显低于前 30 例（p<0.05）。
我们的研究表明，在离体模拟器中进行 30 例 ESD 切除可以显著提高 ESD 技术的安全性和效率。
