A System for Teaching Advanced Colonoscopic Skills and Endoscopic Submucosal Dissection Based on Nonclinical Models

Endoscopic submucosal dissection (ESD) requires skills that the vast majority of endoscopists do not possess. ESD be broken down into component skills and at least three of the necessary skill sets can be taught separately. In the United States most trainees initially participate in half- or full-day courses that utilize ex vivo and in vivo animal models and the great majority learn these advanced skills in the clinical setting. We describe a comprehensive training over a well-defined period using ex vivo porcine or bovine large bowel models. There are five components or modules that make up the training program: (1) bowel wall injections in ex vivo tissue, (2) inanimate figure tracing model to teach scope control, (3) ESD in plastic tube with window cutout over which square of ex vivo tissue is placed, (4) ESD in ex vivo porcine or bovine large bowel, and (5) mucosal wound closure. The authors are in the midst of training a group of residents, fellows, and young attendings using this approach. This approach has not been vetted yet; however, the preliminary results are promising.