Endoscopic submucosal dissection training with pig models in a Western country

Table 1 Technical details of the 30 ESD procedures

	Model type	Organ	Type of knife	Specimen size (mm)	Procedure duration (min)		Immediate complications
					CC	D
1	EV	Stomach	NN + IT	31	28	46	-
2	EV	Stomach	NN + IT	35	23	28	-
3	EV	Esophagus	NN	28	15	35	-
4	EV	Stomach	NN + IT	35	56	33	-
5	EV	Esophagus	NN + IT	31	44	16	NDML
6	EV	Stomach	FN	38	35	23	-
7	EV	Stomach	FN + IT	48	25	60	NDML
8	EV	Stomach	FN + HN	49	35	45	NDML
9	IV	Stomach	FN + IT	48	25	80	-
10	IV	Stomach	NN + IT	67	15	30	NDML
11	IV	Stomach	NN + IT	41	57	23	-
12	IV	Stomach	NN + IT + S	37	38	24	Bleed
13	IV	Stomach	NN + IT	116	60	83	Bleed
14	IV	Stomach	NN + FN + HN + IT	-1	87	196	Perforation
15	IV	Stomach	NN + IT	45	40	91	Bleed
16	IV	Esophagus	NN + FN + HN + IT	45	39	42	-
17	IV	Esophagus	FN + IT	50	55	70	NDML
18	IV	Stomach	NN + IT	45	28	9	-
19	IV	Esophagus	FN + IT	53	42	48	Bleed
20	IV	Stomach	NN + IT	-1	47	26	-
21	IV	Stomach	NN + IT	54	43	27	-
22	IV	Stomach	NN + IT	62	49	27	-
23	IV	Esophagus	NN + FN + HN + IT	32	28	27	-
24	IV	Stomach	NN + IT	62	45	16	-
25	IV	Stomach	NN + IT	45	20	17	-
26	IV	Esophagus	NN + FN + IT	22	8	25	-
27	IV	Esophagus	NN + IT + S	35	17	73	NDML
28	IV	Stomach	FN + IT	51	35	45	Bleed
29	IV	Esophagus	FN + IT	30	32	52	NDML
30	IV	Stomach	NN + IT	32	15	35	-

¹Resection was not completed, and therefore, no specimen was pinned or measured. ESD: Endoscopic submucosal dissection; EV: Ex vivo; IV: In vivo; NN: Needle knife; IT: Insulated-tip knife; HN: Hook knife; FN: Flex knife; S: Snare; CC: Time from marking until circumferential cutting; D: Time from circumferential cutting until end of dissection; Bleed: Bleeding requiring hot forceps coagulation; NDML: Non-transmural damage of the proper muscular layer.

Table 2 Results of the 30 ESD procedures performed in the ex vivo model, in vivo model 1 (first 11 resections in the live pigs), in vivo model 2 (last 11 resections in the live pigs) (mean ± SD)

	n	Size (mm)	Time from marking until circumferential cutting (min)	Time from circumferential cutting until end of dissection (min)	Total time (min)	Proper muscle layer injury (n)	Open perforation (n)	Major bleeding (n)
Esophagus
Ex vivo	2	29.5 ± 2.1	29.5 ± 20.5	25.5 ± 13.4	55.0 ± 7.1	1	0	0
In vivo1	3	49.3 ± 4.0	45.3 ± 8.1	53.3 ± 14.7	98.7 ± 23.2	1	0	0
In vivo2	4	29.7 ± 7.6	21.2 ± 10.9	44.2 ± 22.8	65.5 ± 26.5	2	0	0
Stomach
Ex vivo	6	45.3 ± 8.5	33.7 ± 12.0	39.2 ± 13.7	72.8 ± 15.2	2	0	0
In vivo1	8	57.0 ± 27.7	43.7 ± 23.3	67.0 ± 61.1	110.7 ± 79.5	1	1	0
In vivo2	7	51.0 ±11.3	36.3 ± 13.6	27.6 ± 10.0	65.3 ± 15.7	0	0	0