Endoscopic training on an ex vivo animal model improves endoscopic skills

Czech version

Authors: J. Martínek ¹; Š. Suchánek ¹; M. Stefanová ¹; F. Závada ¹; B. Svobodová ²; A. Štrosová ¹; M. Zavoral ¹
Authors‘ workplace: Interní klinika 1. LF UK a ÚVN Praha, 2Klinika nefrologie, 1. LF UK a VFN v Praze ¹
Published in: Gastroent Hepatol 2012; 66(3): 170-174
Category: Digestive Endoscopy: Original Article

Overview

Backgrounds:
Ex vivo animal models are used for practicing basic as well as advanced endoscopic techniques. The aim of this study was to establish whether such training can improve the quality of endoscopic skills.

Methods:
50 endoscopists participated in the following training courses: endoscopic resection (ER), stenting, application of the OVESCO clip, and endoscopic submucosal dissection (ESD). With the exception of two doctors, all trainees participated in a one-day course (approx. six hours long). Two participants took part in seven ESD courses. Their endoscopic skills were evaluated by independent assessors on a scale of 1–5 (1 = excellent, 5 = insufficient) as well as based on the actual success of the procedure.

Results:
1. Endoscopic resection: Endoscopists (n = 15) improved their skills (before the course assessed as 3.5 and after as 1.5, p < 0.001), seven procedures were assessed as successful before the course (47%); after the training 13 procedures achieved the same result (87%); p = 0.02. 2. Stenting: Participants (n = 15) improved their abilities to place endoscopic auto-expansive metallic and plastic stents. 3. OVESCO clip (n = 10): Participants improved their skills in preparing and applying clips (4.5 before, 2.0 after, p < 0.01). Prior to the training, only one clip application had been successful (10%), whereas the number rose to nine after completion of the course (90%). 4. Endoscopic submucosal dissection (n = 10): Eight participants on the one-day course did not improve their competences (with scores of 4.2 before, 4.0 after, NS). Two participants, who had undertaken seven ESD courses, improved their skills (with scores of 4 before, 1.6 after). Note: given the small number of participants, this finding is insignificant.

Conclusion:
A one-day training course can significantly enhance general endoscopic competence in endoscopic resection, the insertion of stents, and the application of OVESCO clips. In contrast, it does not improve skills in endoscopic submucosal dissection, which requires a greater number of training courses.

Key words:
training – Erlangen Model – stenting – endoscopic resection – endoscopic dissection

Sources

1. Hochberger J, Euler K, Naegel A et al. The Compact Erlangen Active Simulator for Interventional Endoscopy: A prospective comparison in structured team-training courses on endoscopic hemostasis for doctors and nurses to the “Endo-Trainer” model. Scand J Gastroenterol 2004; 39(9): 895–902.

2. Hochberger J, Maiss J. Currently available simulators: ex vivo models. Gastrointest Endosc Clin N Am 2006; 16(3): 435–449.

3. Hochberger J, Matthes K, Maiss J et al. Training with the compactEASIE biologic simulator significantly improves hemostatic skill of gastroenterology fellows: a randomized controlled comparison with clinical endoscopy training alone. Gastrointest Endosc 2005; 61(2): 204–215.

4. Maiss J, Prat F, Wiesnet J et al. The complementary Erlangen active simulator for interventional endoscopy is superior to solely clinical education in endoscopic hemostasis. The French training project: a prospective trial. Eur J Gastroenterol Hepatol 2006; 18(11): 1217–1225.

5. Maiss J, Wiesnet J, Proeschel A et al. Objective benefit of a 1-day training course in endoscopic hemostasis using the “compactEASIE” endoscopy simulator. Endoscopy 2005; 37(6): 552–558.

6. Martínek J, Suchánek S, Stefanová M et al. Training on Ex-vivo Animal Model Improves the Endoscopic Skills: A Randomized, Single-blind Study. Gastroint Endosc 2011; 74(2): 367–373.

7. Martínek J, Suchánek Š, Závada F et al. Trénink endoskopických metod na neživém prasečím modelu – hodnocení účastníky. Gastroent Hepatol 2011; 65(4): 189–194.

8. van Vilsteren FG, Pouw RE, Herrero LA et al. Learning to perform endoscopic resection of esophageal neoplasia is associated with significant complications even within a structured training program. Endoscopy 2012; 44(1): 4–12.

9. Ferlitsch A, Schoefl R, Puespoek A et al. Effect of virtual endoscopy simulator training on performance of upper gastrointestinal endoscopy in patients: a randomized controlled trial. Endoscopy 2010; 42(12): 1049–1056.

10. Bureš J, Rejchrt S, Tachecí I et al. Virtuální simulátor pro digestivní endoskopii. Gastroent Hepatol 2011; 65(6): 348–353.

11. Haycock A, Koch AD, Familiari P et al. Training and transfer of colonoscopy skills: a multinational, randomized, blinded, controlled trial of simulator versus bedside training. Gastrointest Endosc 2010; 71(2): 298–307.

12. Lim BS, Leung JW, Lee J et al. Effect of ERCP mechanical simulator (EMS) practice on trainees' ERCP performance in the early learning period: US multicenter randomized controlled trial. Am J Gastroenterol 2011; 106(2): 300–306.

13. Parra-Blanco A, Arnau MR, Nikolas-Perez D et al. Endoscopic submucosal dissection training with pig models in a Western country.World J Gastroenterol 2010; 16(23): 2895–2900.

14. Berr F, Ponchon T, Neureiter D et al. Experimental Endoscopic Submucosal Dissection Training In A Porcine Model: Learning Experience Of Skilled Western Endoscopists. Dig Endosc 2011; 23(4): 281–289.

15. Tsuji Y, Ohata K, Sekiguchi M et al. An effective training system for endoscopic submucosal dissection of gastric neoplasm. Endoscopy 2011; 43(12): 1033–1038.

16. ASGE Training Committee, Adler DG, Bakis G et al. Principles of training in GI endoscopy. Gastrointest Endosc 2012; 75(2): 231–235.