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Endoscopy 2013; 45(06): 451-457
DOI: 10.1055/s-0032-1326483
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Validation of a live animal model for training in endoscopic hemostasis of upper gastrointestinal bleeding ulcers[1]

M. Camus
1   Gastroenterology and School of Surgery, Lariboisière Hospital, APHP, Paris 7 University, Paris, France
2   Inserm Unit 965, Paris, France
,
P. Marteau
1   Gastroenterology and School of Surgery, Lariboisière Hospital, APHP, Paris 7 University, Paris, France
3   Inserm CRB3, Innovation et Recherche en Endoscopie et en Chirurgie (ITEC), Paris, France
,
M. Pocard
2   Inserm Unit 965, Paris, France
4   Department of Surgery, Lariboisière Hospital, APHP, Paris 7 University, Paris, France
,
C. Bal dit Sollier
5   Laboratory of Hematology Hemostasis and Thrombosis Lariboisière Hospital, APHP, Paris 7 University and Institut des Vaisseaux et du Sang, Paris, France
,
A. Lavergne-Slove
6   Department of Pathology, Lariboisière Hospital, APHP, Paris 7 University, Paris, France
,
A. Thibault
1   Gastroenterology and School of Surgery, Lariboisière Hospital, APHP, Paris 7 University, Paris, France
5   Laboratory of Hematology Hemostasis and Thrombosis Lariboisière Hospital, APHP, Paris 7 University and Institut des Vaisseaux et du Sang, Paris, France
,
S. Lecleire
7   Department of Hepatology and Gastroenterology Rouen University Hospital, Rouen, France
,
A. Vienne
8   Department of Gastroenterology, Cochin Hospital, APHP, Paris 5 University, Paris, France
,
B. Coffin
9   Department of Gastroenterology, Louis Mourier Hospital, APHP, Paris 7 University, Paris, France
,
L. Drouet
5   Laboratory of Hematology Hemostasis and Thrombosis Lariboisière Hospital, APHP, Paris 7 University and Institut des Vaisseaux et du Sang, Paris, France
,
X. Dray
1   Gastroenterology and School of Surgery, Lariboisière Hospital, APHP, Paris 7 University, Paris, France
2   Inserm Unit 965, Paris, France
3   Inserm CRB3, Innovation et Recherche en Endoscopie et en Chirurgie (ITEC), Paris, France
10   Division of Gastroenterology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
› Author Affiliations
Further Information

Publication History

submitted 02 August 2012

accepted after revision 22 January 2013

Publication Date:
03 June 2013 (online)

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Commentaire de travail de Camus M et al., pp. 451Endoscopy 2013; 45(06): 593-593
DOI: 10.1055/s-0033-1344367

Background and study aims: The management of upper gastrointestinal bleeding requires training of the endoscopist. We aimed to validate a live animal model of bleeding ulcers for training in endoscopic hemostasis.

Materials and methods: Bleeding ulcers were created by repeated grasp-and-snare gastric mucosectomies in pigs rendered “bleeders” by preadministration of clopidogrel, aspirin, and unfractionated heparin. The feasibility and reproducibility of the model (proportion of bleeding ulcers, number of ulcers per animal, and time needed to produce a bleeding ulcer) were prospectively evaluated in six animals. Ten endoscopic experts assessed the similarity of this pig model to human bleeding ulcers (four-point Likert scale). The training capabilities of the model for hemostatic techniques (needle injection, bipolar electrocoagulation, and hemoclipping) were evaluated in 46 fellows (four-point Likert scale).

Results: A total of 53 gastric ulcers were created in 6 animals (8.8 ± 1.5 ulcers/animal). Successful active ulcer bleeding (Forrest Ib) was achieved in 96.2 % of cases. Bleeding was moderate to abundant in 79 % of cases. Ulcerations consistently reached the submucosal layer. The mean (± SD) time taken to create a bleeding ulcer was 3.8 ± 0.6 minutes. Endoscopic experts assessed the realism of the ulcers and bleeding at 3.2 ± 0.7 and 3.6 ± 0.7 respectively on a four-point Likert scale. The training significantly improved the endoscopic skills of the 46 fellows (P < 0.0001) in all hemostatic techniques.

Conclusions: The live porcine model of bleeding ulcers was demonstrated to be realistic, reproducible, feasible, time efficient, and easy to perform. It was favorably assessed as an excellent model for training in endoscopic treatment of bleeding ulcers.

1 Note: This study was presented during a free paper session at the United European Gastroenterology Week, London, UK, 21 – 25 November 2010.


 

  • References

  • 1 van Leerdam ME, Vreeburg EM, Rauws EA et al. Acute upper gastrointestinal bleeding: did anything change? Time trend analysis of incidence and outcome of acute upper gastrointestinal bleeding between 1993/1994 and 2000. Am J Gastroenterol 2003; 98: 1494-1499
    PubMedSearch in Google Scholar
  • 2 Di Fiore F, Lecleire S, Merle V et al. Changes in characteristics and outcome of acute upper gastrointestinal haemorrhage: a comparison of epidemiology and practices between 1996 and 2000 in a multicentre French study. Eur J Gastroenterol Hepatol 2005; 17: 641-647
    CrossrefPubMedSearch in Google Scholar
  • 3 Maiss J, Dumser C, Zopf Y et al. “Hemodynamic efficacy” of two endoscopic clip devices used in the treatment of bleeding vessels, tested in an experimental setting using the compact Erlangen Active Simulator for Interventional Endoscopy (compactEASIE) training model. Endoscopy 2006; 38: 575-580
    Thieme ConnectPubMedSearch in Google Scholar
  • 4 Chen VK, Marks JM, Wong RC et al. Creation of an effective and reproducible nonsurvival porcine model that simulates actively bleeding peptic ulcers. Gastrointest Endosc 2008; 68: 548-553
    CrossrefPubMedSearch in Google Scholar
  • 5 Chiu PW, Hu B, Lau JY et al. Endoscopic plication of massively bleeding peptic ulcer by using the Eagle Claw VII device: a feasibility study in a porcine model. Gastrointest Endosc 2006; 63: 681-685
    CrossrefPubMedSearch in Google Scholar
  • 6 Dennis MB, Silverstein FE, Gilbert DA et al. Evaluation of Nd:YAG photocoagulation using a new experimental ulcer model with a single bleeding artery. Gastroenterology 1981; 80: 1522-1527
    PubMedSearch in Google Scholar
  • 7 Hu B, Chung SC, Sun LC et al. Developing an animal model of massive ulcer bleeding for assessing endoscopic hemostatic devices. Endoscopy 2005; 37: 847-851
    Thieme ConnectPubMedSearch in Google Scholar
  • 8 Johnston JH, Jensen DM, Auth D. Experimental comparison of endoscopic yttrium-aluminum-garnet laser, electrosurgery, and heater probe for canine gut arterial coagulation. Importance of compression and avoidance of erosion. Gastroenterology 1987; 92: 1101-1108
    PubMedSearch in Google Scholar
  • 9 Mall AS, Hickman R, Terblanche J et al. The pig as an ulcer model. Gastroenterology 1997; 113: 366-367
    PubMedSearch in Google Scholar
  • 10 Pinkas H, McAllister E, Norman J et al. Prolonged evaluation of epinephrine and normal saline solution injections in an acute ulcer model with a single bleeding artery. Gastrointest Endosc 1995; 42: 51-55
    CrossrefPubMedSearch in Google Scholar
  • 11 Protell RL, Silverstein FE, Piercey J et al. A reproducible animal model of acute bleeding ulcer – the “ulcer maker”. Gastroenterology 1976; 71: 961-964
    PubMedSearch in Google Scholar
  • 12 Randall GM, Jensen DM, Hirabayashi K et al. Controlled study of different sclerosing agents for coagulation of canine gut arteries. Gastroenterology 1989; 96: 1274-1281
    PubMedSearch in Google Scholar
  • 13 Terblanche J, van Hoorn-Hickman R. The prevention of peptic ulceration by highly selective vagotomy in a new peptic ulcer experimental model: the bile duct-ligated pig. Surgery 1978; 84: 206-211
    PubMedSearch in Google Scholar
  • 14 Roussi J, Andre P, Samama M et al. Platelet functions and haemostasis parameters in pigs: absence of side effects of a procedure of general anaesthesia. Thromb Res 1996; 81: 297-305
    CrossrefPubMedSearch in Google Scholar
  • 15 Bowie EJ, Owen Jr CA, Zollman PE et al. Tests of hemostasis in swine: normal values and values in pigs affected with von Willebrand’s disease. Am J Vet Res 1973; 34: 1405-1407
    PubMedSearch in Google Scholar
  • 16 Elmunzer BJ, Trunzo JA, Marks JM et al. Endoscopic full-thickness resection of gastric tumors using a novel grasp-and-snare technique: feasibility in ex vivo and in vivo porcine models. Endoscopy 2008; 40: 931-935
    Thieme ConnectPubMedSearch in Google Scholar
  • 17 Forrest JA, Finlayson ND, Shearman DJ. Endoscopy in gastrointestinal bleeding. Lancet 1974; 2: 394-397
    CrossrefPubMedSearch in Google Scholar
  • 18 Tittle CR, Hill RJ. Attitude measurement and prediction of behavior: an evaluation of conditions and measurement techniques. Sociometry 1967; 30: 199-213
    CrossrefPubMedSearch in Google Scholar
  • 19 Lau JY, Sung J, Hill C et al. Systematic review of the epidemiology of complicated peptic ulcer disease: incidence, recurrence, risk factors and mortality. Digestion 2011; 84: 102-113
    CrossrefPubMedSearch in Google Scholar
  • 20 Elmunzer BJ, Young SD, Inadomi JM et al. Systematic review of the predictors of recurrent hemorrhage after endoscopic hemostatic therapy for bleeding peptic ulcers. Am J Gastroenterol 2008; 103: 2625-2632
    CrossrefPubMedSearch in Google Scholar
  • 21 Desilets DJ, Banerjee S, Barth BA et al. Endoscopic simulators. Gastrointest Endosc 2011; 73: 861-867
    CrossrefPubMedSearch in Google Scholar
  • 22 Cantu P, Penagini R. Computer simulators: the present and near future of training in digestive endoscopy. Dig Liver Dis 2012; 44: 106-110
    CrossrefPubMedSearch in Google Scholar
  • 23 Hochberger J, Euler K, Naegel A et al. The compact Erlangen Active Simulator for Interventional Endoscopy: a prospective comparison in structured team-training courses on “endoscopic hemostasis” for doctors and nurses to the “Endo-Trainer” model. Scand J Gastroenterol 2004; 39: 895-902
    CrossrefPubMedSearch in Google Scholar
  • 24 Hochberger J, Matthes K, Maiss J et al. Training with the compactEASIE biologic endoscopy simulator significantly improves hemostatic technical skill of gastroenterology fellows: a randomized controlled comparison with clinical endoscopy training alone. Gastrointest Endosc 2005; 61: 204-215
    CrossrefPubMedSearch in Google Scholar
  • 25 Maiss J, Wiesnet J, Proeschel A et al. Objective benefit of a 1-day training course in endoscopic hemostasis using the “compactEASIE” endoscopy simulator. Endoscopy 2005; 37: 552-558
    Thieme ConnectPubMedSearch in Google Scholar
  • 26 Jensen DM, Machicado GA. Hemoclipping of chronic canine ulcers: a randomized, prospective study of initial deployment success, clip retention rates, and ulcer healing. Gastrointest Endosc 2009; 70: 969-975
    CrossrefPubMedSearch in Google Scholar
  • 27 Jensen DM, Machicado GA, Hirabayashi K. Randomized controlled study of 3 different types of hemoclips for hemostasis of bleeding canine acute gastric ulcers. Gastrointest Endosc 2006; 64: 768-773
    CrossrefPubMedSearch in Google Scholar