To evaluate the effect of train the trainer profile in ESD simulated training.

Six endoscopists with no ESD experience were included. They firstly received didactic material and theoretical aspects of ESD. Then, they underwent the training program using an ex-vivo animal (swine) model (esophagus-stomach) stimulating the human body ESD procedure. During the following training sequences, the previous trainee acted as an assistant and stimulated the "trainer" to train the next trainee (role transition). We accessed the efficacy of TTT on raising operation level of trainee by comparing the time for total operation , time for mark lesions, time for circumferential incision and recording the en-bloc resection rate and the ESD-related perforation.

Six trainees received 5 rounds TTT training, performed a total of 30 simulation ESD operation in ex-vivo model. The operation time was shortened obviously. The total operating time, circumferential incision time, time for submucosal dissection respectively decreased from (37.33 ± 5.85)min, (12.83 ± 2.93)min, (24.50 ± 3.39)min to (24.50 ± 4.59)min, (7.33 ± 1.63)min, (13.00 ± 3.58)min. Uncomplete resection was achieved in 4 cases and with 1 case of perforation recorded, all occured in the first 3 rounds of training. As showed in the learning curve of the trainee, the duration of ESD operation was shortened and there was no significant difference in operation time after the 4 rounds of training (P>0.05).

TTT training profile is feasible and effective to improve the active learning by role conversion. The operation time were stable after 4 rounds training. However, further study is needed for the in-vivo animal/swine model ESD training.