Effect of Time-Limited Training on Endoscopic Submucosal Dissection in an Ex Vivo Porcine Stomach Model: A Prospective Randomized Controlled Study

Abstract

Introduction Endoscopic submucosal dissection (ESD) is the first choice for superficial tumor resection. There is no report on whether the training effect is affected by limiting the operation time of each ESD operation. This study aimed to prospectively evaluate the efficiency of time-limited ESD training by using an ex vivo porcine stomach model. Methods ESD was performed in accordance with the standard procedure on ex vivo porcine stomach model. The time-limited group required each operation time to be controlled within 30 minutes, and the nonlimited group did not limit the operation time. The en bloc resection rate, surface area of the resected specimen, procedure speed, and perforation rate were compared in the two groups. Results Compared with the en bloc resection rate in the time-limited group, that in the nonlimited group was significantly higher in ESD-1 and ESD-2. In each ESD procedure, the median resection area in the nonlimited group was significantly larger than that in the time-limited group. The difference in median procedure speed between the two groups in ESD-1 to ESD-4 did not reach significance in the statistical analysis. The speed of ESD-5 in the time-limited group was significantly higher than that of the nonlimited group. The perforation rate of the time-limited group was similar to that of the nonlimited group. Conclusion Limiting the training time does not help the trainees to complete large resection of lesions and reduce the perforation rate, but it may help to improve the operation speed.