Gastroenterologie
a hepatologie

Endoscopic training on an ex vivo animal model improves endoscopic skills

Jan Martínek ^{Orcid.org  1,2}, Štěpán Suchánek ^{Orcid.org  3}, Magdalena Stefanová ^{Orcid.org  4}, Filip Závada ^{Orcid.org  5}, Barbora Svobodová ^{Orcid.org  6}, Alice Štrosová ^{Orcid.org  7}, Miroslav Zavoral ^{Orcid.org  3}

+ Affiliation
¹ Klinika hepatogastroenterologie, Transplantcentrum, IKEM, Praha
² Gastroenterologická a endoskopická ambulancia, Interná klinika FZaSP TU a FN Trnava, Slovenská republika
³ Interní klinika 1. LF UK a ÚVN – VFN Praha
⁴ Interní klinika, 1. LF UK a ÚVN Praha
⁵ Gastroenterologie, Oblastní nemocnice Příbram, a.s.
⁶ Klinika nefrologie, 1. LF UK a VFN Praha
⁷ Interní klinika 1. LF UK a ÚVN Praha

Summary

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 abilitiesto 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.

Keywords

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