Traction using a clip-with-line is a preferred method for trainees in performing esophageal endoscopic submucosal dissection: an animal model study

Abstract

Background: The optimal operative process of esophageal endoscopic submucosal dissection (ESD), especially for the beginners, is not established. In this study, the clip-with-line method, the tunneling method and the conventional method for esophageal ESD were compared in a training course on live pigs. Methods: 15 trainee endoscopists were randomized into three groups, the clip-with-line method group, the tunneling method group, and the conventional method group. Each trainee performed four esophageal ESDs on live pigs with one of the specified methods, assisted by a senior endoscopist. The procedural time and speed, the en bloc resection rates, adverse events, and self-completion rates were recorded, and learning curves were drawn. Results: The procedural time in the clip-with-line group was significantly shorter than those in the tunneling and the conventional method group (47.4 ± 9.0 min versus 67.0 ± 15.1 min and 67.0 ± 11.8 min, p = 0.000). The clip-with-line method had the lowest rates of perforation and muscle layer injury among the three methods. The en bloc resection rates and self-completion rates were similar among the three groups. Learning curves analysis showed the clip-with-line method was the easiest one for the trainees to master. Conclusions: The clip-with-line method shortened procedural time for trainees, and was associated with lower rates of adverse events. This method is preferred for endoscopists in their learning periods for esophageal ESD.