Experimental endoscopic submucosal dissection training in a porcine model: Learning experience of skilled western endoscopists

Frieder Berr, Thierry Ponchon, Daniel Neureiter, Tobias Kiesslich, Jelle Haringsma, Georg F. Kaehler, Friedrich Schmoll, Helmut Messmann, Naohisa Yahagi, Tsuneo Oyama

Research output: Contribution to journalArticlepeer-review

74 Citations (Scopus)


Background: Endoscopic submucosal dissection (ESD) demands a new level of endoscopic skill in Europe. A 2-day workshop was set up for trainees to carry out five ESD each in order to obtain the skill level required to perform ESD in the stomach or rectum. This study describes: (i) the workshop setup; (ii) the participant's performance; and (iii) the training effect on post-workshop clinical ESD performance. Methods: Eighteen very experienced European endoscopists participated in four half-day (4.5 h) training sessions, with everybody rotating daily through six separate training stations (two each with dual, hook, or hybrid knives) with expert tutors. One anesthetized piglet was used per station and session. After 1 year, the clinical ESD performance was surveyed to estimate the training effect of the workshop. Results: Overall, 74 ESD were performed, that is, 4.1 ESD per participant. On average ESD lasted 57 min for 6 cm 2 specimens. We detected a 22% rate of perforation (16 of 74 ESD with perforations), mostly attributable to participants with less experience in ESD. Those who started clinical ESD within 1 year after the workshop performed 144 clinical ESD (median 8 [0-20] per trainee) mostly in the stomach (40%) and large bowel (46%) with an acceptable rate of perforation (9.7%) and surgical repair (3.5%) without mortality or persistent morbidity. Conclusion: Intense skill training for ESD is needed to reduce the risk of perforation, as demonstrated by the results of this workshop. We show that experimental ESD training, however, enables skilled European endoscopists to perform ESD in standard locations with moderate risk of perforation during the clinical learning curve.

Original languageEnglish
Pages (from-to)281-289
Number of pages9
JournalDigestive Endoscopy
Issue number4
Publication statusPublished - 2011 Oct


  • animal model
  • early gastrointestinal cancer
  • endoscopic submucosal dissection
  • superficial gastrointestinal neoplasias

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology


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