Skip to main content
Top
Published in: Surgical Endoscopy 10/2010

01-10-2010

In vitro porcine training model for colonic endoscopic submucosal dissection: an inexpensive and safe way to acquire a complex endoscopic technique

Authors: Sophie S. F. Hon, Simon S. M. Ng, Janet F. Y. Lee, Jimmy C. M. Li, Anthony W. I. Lo

Published in: Surgical Endoscopy | Issue 10/2010

Login to get access

Abstract

Background

Colonic endoscopic submucosal dissection (ESD) has developed in recent years to permit en bloc resection of larger colorectal lesions that cannot be done by standard polypectomy or mucosal resection techniques. Colonic ESD is technically demanding and has a steep learning curve. Adequate training is essential to make ESD a reliable treatment for colorectal neoplasms. We aim to share our early experience with an in vitro porcine training model for colonic ESD.

Method

Resected porcine distal colon was used to set up a training model for ESD, which was performed as in human using a standard endoscope and dissecting devices. Size of the lesions, operation time, en bloc resection rate, and perforation rate were recorded.

Results

Ten consecutive colonic ESD procedures were performed by a single endoscopist. Incomplete resection and perforation were encountered during the first two procedures. No perforation occurred in subsequent procedures and the operation time per task also decreased gradually. The setup cost for this model was only around US $30.

Conclusions

The in vitro porcine model is easy and inexpensive to set up. Our initial experience showed that the model could simulate colonic ESD in human and technical proficiency improved by repetition. This simple setup may be a promising training model for endoscopists working in areas with a low incidence of early gastric cancer.
Literature
1.
go back to reference Hurlstone DP, Fujii T, Lobo AJ (2002) Early detection of colorectal cancer using high magnification chromoscopic colonoscopy. Br J Surg 89:272–282CrossRefPubMed Hurlstone DP, Fujii T, Lobo AJ (2002) Early detection of colorectal cancer using high magnification chromoscopic colonoscopy. Br J Surg 89:272–282CrossRefPubMed
2.
go back to reference Hurlstone DP, Cross SS, Adam I, Shorthouse AJ, Brown S, Sanders DS, Lobo AJ (2004) Efficacy of high magnification chromoscopic colonoscopy for the diagnosis of neoplasia in flat and depressed lesions of the colorectum: a prospective analysis. Gut 53:284–290CrossRefPubMed Hurlstone DP, Cross SS, Adam I, Shorthouse AJ, Brown S, Sanders DS, Lobo AJ (2004) Efficacy of high magnification chromoscopic colonoscopy for the diagnosis of neoplasia in flat and depressed lesions of the colorectum: a prospective analysis. Gut 53:284–290CrossRefPubMed
3.
go back to reference Rex DK (2007) Have we defined best colonoscopic polypectomy practice in the United States? Clin Gastroenterol Hepatol 5:674–677CrossRefPubMed Rex DK (2007) Have we defined best colonoscopic polypectomy practice in the United States? Clin Gastroenterol Hepatol 5:674–677CrossRefPubMed
4.
go back to reference Kudo S (1993) Endoscopic mucosal resection of flat and depressed types of early colorectal cancer. Endoscopy 25:455–461CrossRefPubMed Kudo S (1993) Endoscopic mucosal resection of flat and depressed types of early colorectal cancer. Endoscopy 25:455–461CrossRefPubMed
5.
go back to reference Saitoh Y, Fujiya M, Watari J (2008) Endoscopic mucosal resection and endoscopic piecemeal mucosal resection for colorectal neoplasia. In: Niwa H (ed) New challenges in gastrointestinal endoscopy. Springer, Tokyo, pp 346–352CrossRef Saitoh Y, Fujiya M, Watari J (2008) Endoscopic mucosal resection and endoscopic piecemeal mucosal resection for colorectal neoplasia. In: Niwa H (ed) New challenges in gastrointestinal endoscopy. Springer, Tokyo, pp 346–352CrossRef
6.
go back to reference Arebi N, Swain D, Suzuki N, Fraser C, Price A, Saunders BP (2007) Endoscopic mucosal resection of 161 large sessile or flat colorectal polyps. Scand J Gastroenterol 42:859–866CrossRefPubMed Arebi N, Swain D, Suzuki N, Fraser C, Price A, Saunders BP (2007) Endoscopic mucosal resection of 161 large sessile or flat colorectal polyps. Scand J Gastroenterol 42:859–866CrossRefPubMed
7.
go back to reference Kaltenbach T, Friedland S, Maheshwari A, Ouyang D, Rouse RV, Wren S, Soetikno R (2007) Short- and long-term outcomes of standardized EMR of nonpolypoid (flat and depressed) colorectal lesions > or = 1 cm. Gastrointest Endosc 65:857–865CrossRefPubMed Kaltenbach T, Friedland S, Maheshwari A, Ouyang D, Rouse RV, Wren S, Soetikno R (2007) Short- and long-term outcomes of standardized EMR of nonpolypoid (flat and depressed) colorectal lesions > or = 1 cm. Gastrointest Endosc 65:857–865CrossRefPubMed
8.
go back to reference Gotoda T, Yamamoto H, Soetikno RM (2006) Endoscopic submucosal dissection of early gastric cancer. J Gastroenterol 41:929–942CrossRefPubMed Gotoda T, Yamamoto H, Soetikno RM (2006) Endoscopic submucosal dissection of early gastric cancer. J Gastroenterol 41:929–942CrossRefPubMed
9.
go back to reference Ono H, Kondo H, Gotoda T, Shirao K, Yamaguchi H, Saito D, Hosokawa K, Shimoda T, Yoshida S (2001) Endoscopic mucosal resection for treatment of early gastric cancer. Gut 48:225–229CrossRefPubMed Ono H, Kondo H, Gotoda T, Shirao K, Yamaguchi H, Saito D, Hosokawa K, Shimoda T, Yoshida S (2001) Endoscopic mucosal resection for treatment of early gastric cancer. Gut 48:225–229CrossRefPubMed
10.
go back to reference Fujishiro M, Yahagi N, Kakushima N, Kodashima S, Muraki Y, Ono S, Yamamichi N, Tateishi A, Oka M, Ogura K, Kawabe T, Ichinose M, Omata M (2007) Outcomes of endoscopic submucosal dissection for colorectal epithelial neoplasms in 200 consecutive cases. Clin Gastroenterol Hepatol 5:678–683CrossRefPubMed Fujishiro M, Yahagi N, Kakushima N, Kodashima S, Muraki Y, Ono S, Yamamichi N, Tateishi A, Oka M, Ogura K, Kawabe T, Ichinose M, Omata M (2007) Outcomes of endoscopic submucosal dissection for colorectal epithelial neoplasms in 200 consecutive cases. Clin Gastroenterol Hepatol 5:678–683CrossRefPubMed
11.
go back to reference Saito Y, Uraoka T, Matsuda T, Emura F, Ikehara H, Mashimo Y, Kikuchi T, Fu KI, Sano Y, Saito D (2007) Endoscopic treatment of large superficial colorectal tumors: a case series of 200 endoscopic submucosal dissections. Gastrointest Endosc 66:966–973CrossRefPubMed Saito Y, Uraoka T, Matsuda T, Emura F, Ikehara H, Mashimo Y, Kikuchi T, Fu KI, Sano Y, Saito D (2007) Endoscopic treatment of large superficial colorectal tumors: a case series of 200 endoscopic submucosal dissections. Gastrointest Endosc 66:966–973CrossRefPubMed
12.
go back to reference Saito Y, Fukuzawa M, Matsuda T, Fukunaga S, Sakamoto T, Uraoka T, Nakajima T, Ikehara H, Fu KI, Itoi T, Fujii T (2010) Clinical outcome of endoscopic submucosal dissection versus endoscopic mucosal resection of large colorectal tumors as determined by curative resection. Surg Endosc 24(2):343–352CrossRefPubMed Saito Y, Fukuzawa M, Matsuda T, Fukunaga S, Sakamoto T, Uraoka T, Nakajima T, Ikehara H, Fu KI, Itoi T, Fujii T (2010) Clinical outcome of endoscopic submucosal dissection versus endoscopic mucosal resection of large colorectal tumors as determined by curative resection. Surg Endosc 24(2):343–352CrossRefPubMed
13.
go back to reference Tamegai Y, Saito Y, Masaki N, Hinohara C, Oshima T, Kogure E, Liu Y, Uemura N, Saito K (2007) Endoscopic submucosal dissection: a safe technique for colorectal tumors. Endoscopy 39:418–422CrossRefPubMed Tamegai Y, Saito Y, Masaki N, Hinohara C, Oshima T, Kogure E, Liu Y, Uemura N, Saito K (2007) Endoscopic submucosal dissection: a safe technique for colorectal tumors. Endoscopy 39:418–422CrossRefPubMed
14.
go back to reference Bourke M (2009) Current status of colonic endoscopic mucosal resection in the West and the interface with endoscopic submucosal dissection. Dig Endosc 21:S22–S27CrossRefPubMed Bourke M (2009) Current status of colonic endoscopic mucosal resection in the West and the interface with endoscopic submucosal dissection. Dig Endosc 21:S22–S27CrossRefPubMed
15.
go back to reference Tanaka S, Oka S, Kaneko I, Hirata M, Mouri R, Kanao H, Yoshida S, Chayama K (2007) Endoscopic submucosal dissection for colorectal neoplasia: possibility of standardization. Gastrointest Endosc 66:100–107CrossRefPubMed Tanaka S, Oka S, Kaneko I, Hirata M, Mouri R, Kanao H, Yoshida S, Chayama K (2007) Endoscopic submucosal dissection for colorectal neoplasia: possibility of standardization. Gastrointest Endosc 66:100–107CrossRefPubMed
16.
go back to reference Taku K, Sano Y, Fu KI, Saito Y, Matsuda T, Uraoka T, Yoshino T, Yamaguchi Y, Fujita M, Hattori S, Ishikawa T, Saito D, Fujii T, Kaneko E, Yoshida S (2007) Iatrogenic perforation associated with therapeutic colonoscopy: a multicenter study in Japan. J Gastroenterol Hepatol 22:1409–1414CrossRefPubMed Taku K, Sano Y, Fu KI, Saito Y, Matsuda T, Uraoka T, Yoshino T, Yamaguchi Y, Fujita M, Hattori S, Ishikawa T, Saito D, Fujii T, Kaneko E, Yoshida S (2007) Iatrogenic perforation associated with therapeutic colonoscopy: a multicenter study in Japan. J Gastroenterol Hepatol 22:1409–1414CrossRefPubMed
17.
go back to reference Yoshida N, Wakabayashi N, Kanemasa K, Sumida Y, Hasegawa D, Inoue K, Morimoto Y, Kashiwa A, Konishi H, Yagi N, Naito Y, Yanagisawa A, Yoshikawa T (2009) Endoscopic submucosal dissection for colorectal tumors: technical difficulties and rate of perforation. Endoscopy 41:758–761CrossRefPubMed Yoshida N, Wakabayashi N, Kanemasa K, Sumida Y, Hasegawa D, Inoue K, Morimoto Y, Kashiwa A, Konishi H, Yagi N, Naito Y, Yanagisawa A, Yoshikawa T (2009) Endoscopic submucosal dissection for colorectal tumors: technical difficulties and rate of perforation. Endoscopy 41:758–761CrossRefPubMed
18.
go back to reference Yahagi N, Neuhaus H, Schumacher B, Neugebauer A, Kaehler GF, Schenk M, Fischer K, Fujishiro M, Enderle MD (2009) Comparison of standard endoscopic submucosal dissection (ESD) versus an optimized ESD technique for the colon: an animal study. Endoscopy 41:340–345CrossRefPubMed Yahagi N, Neuhaus H, Schumacher B, Neugebauer A, Kaehler GF, Schenk M, Fischer K, Fujishiro M, Enderle MD (2009) Comparison of standard endoscopic submucosal dissection (ESD) versus an optimized ESD technique for the colon: an animal study. Endoscopy 41:340–345CrossRefPubMed
19.
go back to reference Yamamoto H (2007) Technology insight: endoscopic submucosal dissection of gastrointestinal neoplasms. Nat Clin Pract Gastroenterol Hepatol 4:511–520CrossRefPubMed Yamamoto H (2007) Technology insight: endoscopic submucosal dissection of gastrointestinal neoplasms. Nat Clin Pract Gastroenterol Hepatol 4:511–520CrossRefPubMed
Metadata
Title
In vitro porcine training model for colonic endoscopic submucosal dissection: an inexpensive and safe way to acquire a complex endoscopic technique
Authors
Sophie S. F. Hon
Simon S. M. Ng
Janet F. Y. Lee
Jimmy C. M. Li
Anthony W. I. Lo
Publication date
01-10-2010
Publisher
Springer-Verlag
Published in
Surgical Endoscopy / Issue 10/2010
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-010-0982-5

Other articles of this Issue 10/2010

Surgical Endoscopy 10/2010 Go to the issue