Brief Article
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Dec 7, 2013; 19(45): 8326-8334
Published online Dec 7, 2013. doi: 10.3748/wjg.v19.i45.8326
Gastric endoscopic submucosal dissection: From animal model to patient
Nicolás González, Adolfo Parra-Blanco, Miguel Villa-Gómez, Alejandra Gamba, Andrés Taullard, Anaulina Silveira, Alberto Sanguinetti, Carolina Olano, Henry Cohen
Nicolás González, Miguel Villa-Gómez, Alejandra Gamba, Andrés Taullard, Alberto Sanguinetti, Carolina Olano, Henry Cohen, Department of Gastroenterology, Faculty of Medicine, Hospital de Clínicas, Montevideo 11600, Uruguay
Adolfo Parra-Blanco, Department of Gastroenterology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago 6510260, Chile
Anaulina Silveira, Department of Quantitative Methods, Hospital de Clínicas, Montevideo 11600, Uruguay
Author contributions: González N designed the research; González N, Parra-Blanco A, Villa-Gómez M, Gamba A, Taullard A, Sanguinetti A and Olano C performed the research; González N, Parra-Blanco A and Silveira A analyzed the data; González N, Parra-Blanco A and Cohen H drafted the manuscript; all authors read and approved the final manuscript.
Supported by Department of Gastroenterology, Hospital de Clínicas, Montevideo, Uruguay
Correspondence to: Nicolás González, Assistant Professor, Department of Gastroenterology, Hospital de Clínicas, Av Italia 2870-Piso 4, Montevideo 11600, Uruguay. nicolasendoscopia@yahoo.es
Telephone: +598-2-4808472 Fax: +598-2-4808472
Received: May 29, 2013
Revised: August 9, 2013
Accepted: September 16, 2013
Published online: December 7, 2013
Processing time: 202 Days and 16 Hours
Abstract

AIM: To assess whether the use of porcine models is useful for learning endoscopic submucosal dissection (ESD), thus contributing to its subsequent application in human patients.

METHODS: This study/learning process was carried out in 3 phases: Phase I: Ex vivo animal; Phase II: In vivo animal; Phase III: Humans. One endoscopist performed 30 gastric ESDs in porcine models, and later 5 gastric ESDs in 5 patients. The ESD was done following the method practiced at the National Cancer Center in Tokyo, Japan. Technical aspects, size, time and speed of ESD, as well as complications were registered. In patients, their clinical, endoscopic and histologic evolution was additionally added.

RESULTS: Thirty en bloc ESDs were carried out in animal models. The mean ± SD size of the pieces was of 28.4 ± 1.2 mm, and the time of ESD was 41.7 ± 2.4 min. The time of ESD in the first 15 procedures was 43.0 ± 3.0 min whereas in the next 15 procedures, the time was 40.3 ± 3.9 min, P = 0.588. The speed in the first 15 ESDs was 1.25 ± 0.11 cm2/min vs 2.12 ± 0.36 cm2/min in the remaining 15, P = 0.028. There were no complications. In patients, 5 lesions were resected en bloc. The size of the pieces was 25.2 ± 5.1 mm and the time was 85.0 ± 25.6 min. Endoscopic and histological controls did not show evidence of residual neoplastic tissue.

CONCLUSION: A sequential ESD training program of a unique endoscopist, based on the practice in porcine models, contributed to learning ESD for its subsequent application in humans, yielding good results in efficacy and safety.

Keywords: Endoscopic submucosal dissection; Porcine models; Animal models; Training

Core tip: This study was conducted with the purpose of determining in a prospective manner the results, the efficacy and safety of learning endoscopic submucosal dissection (ESD), in porcine models and assessing whether this practice contributes to subsequent application of this technique in patients. The present study shows interesting findings in this regards. The authors have demonstrated the value of a sequential ESD program and believe that it can contribute to disseminate this technique and encourage its learning mostly in western countries where it is still not a common practice for different reasons.