Transferring Endoscopic Submucosal Dissection Skills From Hands-on to Human Cases

This report from The Netherlands describes the results of a survey of 118 participants in an endoscopic submucosal dissection (ESD) training workshop using live porcine models. There were 40 survey respondents (34%), of whom 19 (47%) performed human ESD after the workshop. 

Before clinical practice of ESD, all of the workshop participants trained with live animals and 68% with explants. Most started in the lower third of the stomach or rectum (90%) with lesions ≤30 mm in size (89%). Median ESD performance in humans over a mean of 3.9 years was 19 cases, with adverse events in <10% and R0 resection reported at 88%.

The course participants considered the training with live animals an essential prerequisite (89%). However, only 63% of participants considered explant experience essential, and the value of explant experience was rated lower than that with live animal models. 

Male participants were more likely than female participants to progress to human ESD (56.7% vs 20%, respectively). Most of those who advanced to ESD worked in academic or tertiary centers (79%). The most common reasons reported for not initiating human ESD were inadequate endoscopic unit resources (38%) and an insufficient number of human cases appropriate for ESD (24%).