In vitro porcine training model for colonic endoscopic submucosal dissection: an inexpensive and safe way to acquire a complex endoscopic technique

Colonic endoscopic submucosal dissection (ESD) has developed in recent years to permit en bloc resection of larger colorectal lesions that cannot be done by standard polypectomy or mucosal resection techniques. Colonic ESD is technically demanding and has a steep learning curve. Adequate training is essential to make ESD a reliable treatment for colorectal neoplasms. We aim to share our early experience with an in vitro porcine training model for colonic ESD.Resected porcine distal colon was used to set up a training model for ESD, which was performed as in human using a standard endoscope and dissecting devices. Size of the lesions, operation time, en bloc resection rate, and perforation rate were recorded.Ten consecutive colonic ESD procedures were performed by a single endoscopist. Incomplete resection and perforation were encountered during the first two procedures. No perforation occurred in subsequent procedures and the operation time per task also decreased gradually. The setup cost for this model was only around US $30.The in vitro porcine model is easy and inexpensive to set up. Our initial experience showed that the model could simulate colonic ESD in human and technical proficiency improved by repetition. This simple setup may be a promising training model for endoscopists working in areas with a low incidence of early gastric cancer.