Zheng Linfu, Chen Longping, Wang Fuqiang, Liu Zhilin, Gao Xingjie, Zhou Linxin, Lin Kun, Wang Zaixia, Luo Baoxiang, Li Dazhou, Wang Wen
Department of Gastroenterology, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, 350025, China.
Department of Gastroenterology, 900TH Hospital of PLA Joint Logistics Support Force, Fuzhou, 350025, China.
BMC Med Educ. 2025 Jul 10;25(1):1031. doi: 10.1186/s12909-025-07491-2.
Good exposure of the submucosal visual field is a prerequisite for successful endoscopic submucosal dissection (ESD). There are few reports on ESD training using orthodontic rubber band combined with magnetic ring traction (ORB-MR). This study evaluated the efficacy of ORB-MR traction for ESD training.
This study utilized an ex vivo porcine gastric model. Doctors experienced in endoscopic mucosal resection (> 100 cases), but not in ESD, were randomly divided into conventional and ORB-MR-assisted ESD groups. The practicality of ORB-MR traction was evaluated and procedure outcomes were compared between the two groups. The cumulative sum (CUSUM) method was used to construct the learning curves of ORB-MR and traditional ESD trainees respectively.
A questionnaire survey of the ORB-MR-ESD group showed good satisfaction with ORB-MR. Per-Protocol analysis showed that the resection speed was faster in the ORB-MR group compared to the ESD group (11.61 ± 3.79 mm/min vs. 6.66 ± 2.29 mm/min, p < 0.001). Additionally, the former group exhibited a shorter operative time, lower submucosal injection volume, better visual field satisfaction, and a lower muscle injury rate. The learning curve of the ORB-MR physician reached the learning inflection point in case 9, while the learning inflection point of the traditional ESD physician appeared later, at case 13.
ORB-MR traction proved feasible and practical for ESD. It shortened the learning curve for ESD trainees and exhibited potential as a valuable method for ESD training.
良好的黏膜下视野暴露是成功进行内镜黏膜下剥离术（ESD）的前提条件。关于使用正畸橡皮筋联合磁环牵引（ORB-MR）进行ESD培训的报道较少。本研究评估了ORB-MR牵引在ESD培训中的效果。
本研究采用离体猪胃模型。将有内镜黏膜切除术经验（>100例）但无ESD经验的医生随机分为传统ESD组和ORB-MR辅助ESD组。评估ORB-MR牵引的实用性，并比较两组的手术结果。分别采用累积和（CUSUM）法构建ORB-MR组和传统ESD组学员的学习曲线。
对ORB-MR-ESD组的问卷调查显示，对ORB-MR的满意度较高。符合方案分析表明，ORB-MR组的切除速度比ESD组快（11.61±3.79毫米/分钟对6.66±2.29毫米/分钟，p<0.001）。此外，前一组的手术时间更短，黏膜下注射量更低，视野满意度更高，肌肉损伤率更低。ORB-MR组医生的学习曲线在第9例时达到学习拐点，而传统ESD组医生的学习拐点出现得较晚，在第13例。
ORB-MR牵引被证明对ESD是可行和实用的。它缩短了ESD学员的学习曲线，并展现出作为ESD培训的一种有价值方法的潜力。
