Feasibility of Duodenal Endoscopic Submucosal Dissection Training Using Thiel-Embalmed Cadavers

Background and study aims: Duodenal endoscopic submucosal dissection (ESD) is technically challenging and associated with a high risk of adverse events. We evaluated duodenal ESD feasibility using cadaver surgical training (CST) with Thiel-embalmed cadavers. Patients and methods: Four Thiel-embalmed cadavers underwent upper gastrointestinal endoscopy, followed by simulated duodenal ESD. Seven endoscopists participated, including three experts and four trainees. The participants completed questionnaires evaluating procedural realism, technical difficulty, and educational value. Results: Upper gastrointestinal endoscopy was completed in all four cadavers, and duodenal ESD was conducted on seven simulated lesions. As occasionally encountered in clinical practice, the thin duodenal submucosal layer resulted in perforation in two lesions. The questionnaire responses demonstrated high median scores for procedural realism in upper gastrointestinal endoscopy and duodenal ESD. Participants agreed that CST closely replicated endoscopy in living patients and helped acquire duodenal ESD skills. Although psychological stress related to cadaver handling was reported, all participants expressed willingness to participate in future CST. Conclusions: Thiel-embalmed CST preserved the gastrointestinal mucosal architecture and was feasible for upper gastrointestinal endoscopy and duodenal ESD, suggesting its potential as a training model, warranting further validation with objective educational outcome measures.