Subscribe to RSS
DOI: 10.1055/s-0042-114980
An innovative ex-vivo porcine upper gastrointestinal model for submucosal tunnelling endoscopic resection (STER)
Publication History
submitted12 February 2016
accepted after revision29 July 2016
Publication Date:
14 September 2016 (online)
Background and study aims: Submucosal tunnelling endoscopic resection (STER) is a novel endoscopic technique to remove submucosal tumour (SMT). We propose a novel, low cost simulator for training of techniques for STER.
Patients and methods: The model consisted of an ex-planted porcine oesophagus, stomach and duodenum with marbles embedded surgically in the submucosal plane. Two expert endoscopists with experience in submucosal tunnelling and 5 board-certified endoscopists with no experience in submucosal tunnelling were recruited. Participants were asked to perform a diagnostic endoscopy and 2 STER procedures, 1 in the oesophagus and 1 in the stomach. They also answered a structured questionnaire. Factors including operative time, mucosal and muscular injury rate, injection volume and accuracy of endoscopic closure were assessed.
Results: The median time for localization of all SMTs was 40.1 seconds for experts and 38.5 seconds for novices (P = 1.000). For esophageal STER, the length of mucosal incisions and tunnelling distances were comparable between the 2 groups. The median volume injected by the novice group was significantly lower than the experts (15 mL vs 42.5 mL (P = 0.05). The median tunnelling time per length was 25.9 seconds/mm for the experts and 40.8 seconds/mm for the novice group (P = 0.38). There was a higher rate of mucosal injury and muscular perforation in the novice group (8 vs 0; P = 0.05). For gastric STER, the length of mucosal incisions and tunnel distances were comparable between the 2 groups. The median tunnelling time per length for the experts was 23.3 seconds/mm and 34.6 seconds/mm for the novice group (P = 0.38). One mucosal injury was incurred by a novice. The rate of dissection in the stomach and the oesophagus was not statistically different (P = 0.620). All participants voted that the model provides a realistic simulation and recommended it for training.
Conclusions: STER is an advanced endoscopic technique where its indication is currently explored. Experienced and novice STER endoscopists have expressed the usefulness of this model as a training tool. This low-cost model can be used for future research in STER.
-
References
- 1 Zhao H, Sheng H, Huang L et al. Submucosal tunnelling endoscopic resection in the treatment of esophageal submucosal tumours originating from muscularis propria layer. Zhonghua Wei Chang Wai Ke Za Zhi 2015; 18: 478-482
- 2 Wang H, Tan Y, Zhou Y et al. Submucosal tunnelling endoscopic resection for upper gastrointestinal submucosal tumours originating from the muscularis propria layer. Eur J Gastroenterol Hepatol 2015; 27: 776-780
- 3 Reinehr R. Endoscopic submucosal excavation (ESE) is a safe and useful technique for endoscopic removal of submucosal tumours of the stomach and the oesophagus in selected cases. Z Gastroenterol 2015; 53: 573-578
- 4 Bar-Meir S. Simbionix simulator. Gastrointest Endosc Clin N Am 2006; 16: 471-478
- 5 American Gastroenterological Association. Institute medical position statement on the management of gastric subepithelial masses. Gastroenterology 2006; 130: 2215-2216
- 6 Lee IL, Lin PY, Tung SY et al. Endoscopic submucosal dissection for the treatment of intraluminal gastric subepithelial tumours originating from the muscularis propria layer. Endoscopy 2006; 38: 1024-1028
- 7 Hwang JC, Kim JH, Kim JH et al. Endoscopic resection for the treatment of gastric subepithelial tumours originated from the muscularis propria layer. Hepatogastroenterology 2009; 56: 1281-1286
- 8 Sumiyama K, Gostout CJ, Rajan E et al. Submucosal endoscopy with mucosal flap safety valve. Gastrointest Endosc 2007; 65: 688-694
- 9 Inoue H, Minami H, Kobayashi Y et al. Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy 2010; 42: 265-271
- 10 Xu MD, Cai MY, Zhou PH et al. Submucosal tunnelling endoscopic resection: a new technique for treating upper GI submucosal tumours originating from the muscularis propria layer (with videos). Gastrointestinal Endoscopy 2012; 75: 195-199
- 11 Lee CK, Lee SH, Chung IK et al. Endoscopic full-thickness resection of a gastric subepithelial tumor by using the submucosal tunnel technique with the patient under conscious sedation (with video). Gastrointest Endosc 2012; 75: 457-459
- 12 Inoue H, Ikeda H, Hosoya T et al. Submucosal endoscopic tumor resection for subepithelial tumors in the esophagus and cardia. Endoscopy 2012; 44: 225-230
- 13 Gong W, Xiong Y, Zhi F et al. Preliminary experience of endoscopic submucosal tunnel dissection for upper gastrointestinal subepithelial tumours. Surg Endosc 2014; 28: 524-530
- 14 Ye LP, Zhang Y, Mao XL et al. Submucosal tunnelling endoscopic resection for small upper gastrointestinal subepithelial tumours originating from the muscularis propria layer. Surg Endosc 2014; 28: 524-530
- 15 Wang L, Ren W, Zhang Z et al. Retrospective study of endoscopic submucosal tunnel dissection (ESTD) for surgical resection of esophageal leiomyoma. Surg Endosc 2013; 27: 4259-4266
- 16 Clark W, Velanovich V. Porcine esophageal-gastric explants: a feasible training model for peroral endoscopic myotomy (POEM). Abstract Mo2074. SAGES conference: 2012
- 17 Hochberger J, Neumann M, Hohenberger W et al. New endoscopy trainer for flexible therapeutic endoscopy [German]. Z Gastroenterol 1997; 35: 722-723
- 18 Hochberger J, Maiss J. Currently available simulators: ex vivo models. Gastrointest Endosc Clin N Am 2006; 16: 435-439