This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Research article
HMC Shantha Kumara
Lenox Hill Hospital
Corresponding Author
ORCiD: https://orcid.org/0000-0001-9106-797X
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
ESD is the gold standard treatment for large sessile adenomas yet US adoption rates are low. In ESD, tissue is cut only when the scope tip, with hot knife extended, is moving; this requires different skills than needed for snare polypectomy (scope tip held still). Scope tip control and ESD training methods are needed. A program including an inanimate figure tracing model (FTM; Model1), ex vivo pig stomach model (PSM; Model2) and bovine colon model was devised. This paper concerns preliminary results for models 1 and 2.
Methods
A straight hollow plastic tube with a window cutout 15cm from its end was used for both models (slotted sponge = “anus”). For the FTM a paper with a line figure is placed in the window. After endoscope insertion and positioning the figure is traced with a catheter "pen"; 8 tracings (4 figure types) and 1 pig ESD were done per session. In the PSM a piece of pig stomach and Bovie pad was placed over the window. After “lifting” the mucosa ESD resection of a "polyp" was done. Time/accuracy were tracked for both models as were bowel wall injuries in the PSM.
Results
A total of 30 FTM sessions and PSM cases were done (2 trainees). Completion times and accuracy improved over 8 FTM sessions for less experienced trainee A but not for trainee B. A total of 29/30 PSM cases were completed. The number of deep muscle injuries decreased with time, however, case length correlated with tissue quality and not number of cases. Lifting and tissue conductivity problems were noted in poor quality tissue.
Conclusions
Despite model related issues, both models are feasible and allow trainees to learn scope tip control and ESD; clearly, more study is needed. A smaller diameter tube and use of fresh stomach are advised.
Keywords
ESD, endoscopic training, ex vivo pig stomach model, inanimate training models
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This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Research article
HMC Shantha Kumara
Lenox Hill Hospital
Corresponding Author
ORCiD: https://orcid.org/0000-0001-9106-797X
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
History
CURRENT STATUS: Posted
Version 1
Posted 03 Jan, 2020
Community comments: 6
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
ESD is the gold standard treatment for large sessile adenomas yet US adoption rates are low. In ESD, tissue is cut only when the scope tip, with hot knife extended, is moving; this requires different skills than needed for snare polypectomy (scope tip held still). Scope tip control and ESD training methods are needed. A program including an inanimate figure tracing model (FTM; Model1), ex vivo pig stomach model (PSM; Model2) and bovine colon model was devised. This paper concerns preliminary results for models 1 and 2.
Methods
A straight hollow plastic tube with a window cutout 15cm from its end was used for both models (slotted sponge = “anus”). For the FTM a paper with a line figure is placed in the window. After endoscope insertion and positioning the figure is traced with a catheter "pen"; 8 tracings (4 figure types) and 1 pig ESD were done per session. In the PSM a piece of pig stomach and Bovie pad was placed over the window. After “lifting” the mucosa ESD resection of a "polyp" was done. Time/accuracy were tracked for both models as were bowel wall injuries in the PSM.
Results
A total of 30 FTM sessions and PSM cases were done (2 trainees). Completion times and accuracy improved over 8 FTM sessions for less experienced trainee A but not for trainee B. A total of 29/30 PSM cases were completed. The number of deep muscle injuries decreased with time, however, case length correlated with tissue quality and not number of cases. Lifting and tissue conductivity problems were noted in poor quality tissue.
Conclusions
Despite model related issues, both models are feasible and allow trainees to learn scope tip control and ESD; clearly, more study is needed. A smaller diameter tube and use of fresh stomach are advised.
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6
Figure 7
Figure 8
Figure 9
Figure 10
Figure 11
Figure 12
Figure 13
Figure 14
Figure 15
Figure 16
Figure 17
Figure 18
Figure 19
Figure 20
Figure 21
Figure 22
Figure 23
This is a list of supplementary files associated with this preprint. Click to download.
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