Randomized comparative evaluation of endoscopic submucosal dissection self-learning software in France and Japan

Background and study aim: Endoscopic submucosal dissection (ESD) is currently the reference method to achieve an en bloc resection for large lesions; however, the technique is difficult and risky, with a long learning curve. In order to reduce the morbidity, training courses that use animal models are recommended. Recently, self-learning software has been developed to assist students in their training. The aim of this study was to evaluate the impact of this tool on the ESD learning curve. Methods: A prospective, randomized, comparative study enrolled 39 students who were experienced in interventional endoscopy. Each student was randomized to one of two groups and performed 30 ESDs of 30mm standardized lesions in a bovine colon model. The software group used the self-learning software whereas the control group only observed an ESD procedure video. The primary outcome was the rate of successful ESD procedures, defined as complete en bloc re-section without any perforation and performed in less than 75 minutes. Results: A total of 39 students performed 1170 ESDs. Success was achieved in 404 (70.9 %) in the software group and 367 (61.2 %) in the control group (P=0.03). Among the successful procedures, there were no significant differences between the software and control groups in terms of perforation rate (22 [4.0 %] vs. 29 [5.1 %], respectively; P=0.27) and mean (SD) procedure duration (34.1 [13.4] vs. 32.3 [14.0] minutes, respectively; P=0.52). For the 30th procedure, the rate of complete resection was superior in the software group (84.2 %) compared with the control group (50.0 %; P=0.01). Conclusion: ESD self-learning software was effective in improving the quality of resection compared with a standard teaching method using procedure videos. This result suggests the benefit of incorporating such software into teaching programs.