Oral sodium phosphate for bowel preparation in endoscopic submucosal dissection training in a pig model: A pilot study

SummaryBackgroundThe technical complexity of endoscopic submucosal dissection (ESD) demands adequate training to lower the surgical risks. The diameter and mucosal structure of the porcine colon is similar to the human colon making the pig a good animal for colonoscopic procedure training. However, a standardized animal bowel preparation used in colonic ESD training has not been established.MethodsColonoscopic procedures were performed in 12 pigs, divided into four groups. The control group (Group 1) fasted and received no preprocedure preparation. Group 2 received a single dose of sodium phosphate 2 mL/kg; Group 3 and Group 4 received split doses of sodium phosphate (2 mL/kg and 4 mL/kg, respectively). An experienced endoscopist, blinded to the preparation method, assigned a score from excellent (4 points) to poor (1 point) at five regions of the colon. The final mean bowle cleansing score was calculated from five regions in each pig. Serum biochemistry and electrolyte levels were analyzed.ResultsThe different doses of sodium phosphate preparations did not change the serum glucose, creatinine, sodium, potassium, calcium, or phosphorus levels. The colonic cleansing scores in Group 1 (1.3 ± 0.4; mean ± standard deviation) and Group 2 (1.5 ± 0.2) were lower than those of Group 3 (2.6 ± 0.6) and Group 4 (3 ± 0.2).ConclusionThe use of oral sodium phosphate is easy and safe in porcine bowel preparation for ESD training. Bowel preparation using a split dose of 2 mL/kg or 4 mL/kg sodium phosphate produces an adequate bowel cleansing. The optimal dosage still needs to be established in a large-scale study.