ADVANCED ENDOSCOPIC POLYPECTOMY SKILLS ACQUISITION VIA A NOVEL BENCH-TOP TRAINING PROGRAM.

Yohei Kono¹, Kota Momose¹, Talal Alzghari¹, Reem Alharbi², Patrick Dolan¹, Jackly Juprasert¹, Russell Corwin¹, Andrew Harvey¹, Takahiro Hiratsuka³, Jeffrey Milsom¹, Sam K Sharma¹. ¹Weill Cornell Medicine, ²Princess Nourah bint Abdulrahman University, ³Oita University

Introduction: Hypothesis – to determine whether a bench-top combination training model and program could lead to the acquisition of advanced ESD skills in a group of trainees of varying endoscopic experience.

Complex endoscopic skills needed for procedures such as ESD require stepwise training methods to build confidence and neuromuscular pathways (‘muscle-memory’). The lack of suitable Western training models/methods may partly account for ESD’s relatively low uptake. In Japan, ESD training follows a program of increased difficulty leading to operator competence. We aimed to simulate some of these core principles in our model and training program.

Methods: We constructed a 3-D printed abdomino-pelvic housing into which we attached silicone inserts to mimic the abdominal wall. Fresh porcine distal colon was mounted within the housing to give an accurate human anatomical representation. 3cm diameter pseudopolyps were marked on the mucosal surface using electrocautery. 2 trainees of varying endoscopic experience but no ESD experience participated (Trainee A>1000 endoscopies, Trainee B=0 endoscopies). Parameters measured were; total procedure time, negative horizontal margin rate and perforation rate. The training program consisted 30 rectal ESD’s followed by 6 procedures at different proximal anatomical locations (descending (n=6), transverse (n=6) and cecum(n=6)) to incrementally increase difficulty and build on previously acquired skills. All procedures were video recorded and feedback given to the trainee post-procedure. All procedures were performed using standard endoscopic equipment

Results: 2 trainees performed a total of 96 ESD procedures. All procedures were completed.

Trainee A (n=48): Total mean procedure time was 30.0 ± 10.1 (mean ± SD) min. No perforations were observed. Regression analysis showed decreasing trend at each anatomical location (Rectum: R²=0.42, Descending colon: R²=0.81, Transverse colon: R²=0.48, Cecum: R²=0.49).

Trainee B (n=48): (no colonoscopy experience). Total mean procedure time was 28.8 ± 12.7 (mean ± SD) min. Perforation rate was 6.3% (3/48). Regression analysis showed decreasing trend over time at the rectum, transverse colon and cecum (Rectum: R²=0.46, Transverse colon: R²=0.96, Cecum: R²=0.89).

Learning curve: Total procedure time decreased significantly from the first half of the training program to last (Trainee A: p<0.001, Trainee B: p=0.003).

Conclusions: The training model and program led to the acquisition of advanced endoscopic skills in both trainees. Previous endoscopic experience did not affect skill acquisition. Such a training program should be considered for all clinicians undertaking ESD as part of clinical practice.