Endoscopy on a Human Cadaver: A Feasibility Study as a Training Tool

Abstract

Background: Simulation device and porcine models are increasingly being used for training in gastrointestinal endoscopy. However reports on the use of human cadaver for training in diagnostic or therapeutic endoscopy are limited. Method: Human cadavers were preserved at our center in a customized non formalin based solution which retains organoleptic properties (preserves the colour, feel, inflation of gut). We studied the feasibility of using these cadavers for training in endoscopy. Endoscopy was performed using PENTAX/ EP 2940 with a light source processor PENTAX/EPM 3500. Participants performed endoscopy and submucosal injection on cadaver as well as simulator. Before and after simulator and cadaver training, attendees completed a questionnaire on intubation, manoeuvring esophagus, stomach and duodenum for diagnostic endoscopy and scope positioning, needle out, submucosal injection and elevation of mucosa and needle in. The steps of ESD- marking, precut and submucosal dissection were attempted on the stomach of human cadaver. Results: Ten participants with very little prior experience of endoscopy felt the cadaver based training more beneficial in obtaining the sub mucosal plane and positioning the needle for four quadrant injection as compared to the endoscopic simulator (ES). The attendees felt that while ES has the advantage of providing feedback for the procedure, training on cadaver gave more realistic tactile experience and feel of the elasticity of the gut wall. Overall, diagnostic endoscopy was comparable in both cadaver and simulator except for difficulty in intubation in the former due to supine cadaver position. The steps of ESD were done only in the cadaver with limited success. Conclusion: This study shows the feasibility of using human cadaver for simulation-based training programs in gastrointestinal encoscopy.