A Steep Early Learning Curve for Endoscopic Submucosal Dissection in the Live Porcine Model

Ricardo Küttner-Magalhães, Mário Dinis-Ribeiro, Marco J. Bruno, Ricardo Marcos-Pinto, Carla Rolanda, Arjun D. Koch*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

2 Citations (Scopus)
29 Downloads (Pure)


Background: Endoscopic submucosal dissection (ESD) is a demanding procedure requiring high level of expertise. ESD training programs incorporate procedures with live animal models. This study aimed to assess the early learning curve for performing ESD on live porcine models by endoscopists without any or with limited previous ESD experience. Methods: In a live porcine model ESD workshop, number of resections, completeness of the resections, en bloc resections, adverse events, tutor intervention, type of knife, ESD time and size of resected specimens were recorded. ESD speed was calculated. Results: A total of 70 procedures were carried out by 17 trainees. The percentage of complete resections, en bloc resections and ESD speed increased from the first to the latest procedures (88.2%-100%, 76.5%-100%, 8.6-31.4 mm2/min, respectively). The number of procedures in which a trainee needed tutor intervention and the number of adverse events also decreased throughout the procedures (4 to 0 and 6 to 0, respectively). During the workshop, when participants changed to a different type of knife, ESD speed slightly decreased (18.5 mm2/min to 17.0 mm2/min) and adverse events increased again (0-2). Conclusions: Through successive procedures, complete resections, en bloc resections, and ESD speed improve whereas adverse events decrease, supporting the role of the live porcine model in the preclinical learning phase. Changing ESD knives has a momentarily negative impact on the learning curve.

Original languageEnglish
Pages (from-to)816-825
Number of pages10
JournalDigestive Diseases
Issue number6
Publication statusPublished - Nov 2022

Bibliographical note

Funding Sources:
This research did not receive any specific grant from funding
agencies in the public, commercial, or nonprofit sectors. The
workshop that allowed the present study was unrestrictedly sponsored by Pentax® (Tokyo, Japan), ERBE® (Tübingen, Germany),
and Cook Medical® (Winston-Salem, NC, USA) which provided
flexible endoscopes, electrosurgical units, and endoscopic devices.
The sponsors had no influence on the scientific content of the
workshop neither on this study.

Publisher Copyright:
© 2021 The Author(s) Published by S. Karger AG, Basel.


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