1. Development and Testing of a New, Simple and Inexpensive Ex-Vivo, ERCP Training Model for Basic and Intermediate ERCP Skills
Marco A. D’Assuncao1, Lucia Fry2, Klaus Monkemuller2
Introduction: The keys of therapeutic intervention in endoscopic retrograde cholangiopancreatography (ERCP) are cannulation, stent insertion and stone removal, but lack of training and experience leads to a higher risk of complications. However, many existing models are expensive, not widely available or rely on live animals. In addition, using live and non-live biologic models requires dedicated equipement and scopes. There is need to develop cheap and accessible ERCP models that do not rquire purchase and acquisition of dedicated scopes1,2.
Aim: To develop and test a cheap and reproducible and accessible ERCP model that could be used in any endoscopy unit in the World.
Methods: The model is build of easily accessible devices such as plastic container, PVC tubing, rubbers and molds. The model is based on a plastic container and consists of a silicone-replicated upper gastrointestinal tract from a new vacuum cleaner tube. The part of the model corresponding to the second portion of the duodenum contains non-biologic replicated papilla (rubber), to which transparent plastic tubing corresponding to the pancreatic and biliary ducts are attached. The “fluoroscopy system” consists of a smarphone is mounted on a smartphone holder and connected to a television screen by means of an HDMI cable, providing a black and white image. This creates a simulation of two independent systems in independent screens: the video endoscopy and fluoroscopy. After constructing the model we evaluated its functionality and usefulness. Five endoscopists tested the model during four separate hands-on sessions. The participants answered a questionnaire based on a visual analogue scale of Liker (VAS) evaluating 10 endpoints such as: visual and tactile similarity, successful cannulation, papillary anatomy, visual realism, wire manipulation, usefulness and easiness of use.
Results: Participants found this model to be practical (9, range 7-10), useful to learn (8, range 6-10), and practical (9, 8-10). The VAS easiness of use was (9, range 8-10). The following maneuvers could be performed: endoscope positioning, cannulation of the bilary and pancreatic ducts, wire advancement, stent placement, stone removal. There were no damages or technical problems with the model.
Conclusion: This simple, easy to construct, cheap, non-biologic ERCP model provides a suitable training environment for learning and practicing the key endoscopic maneuvers in ERCP. The model was realistic, easy to use, and practical. The box holding the duodenum and bile ducts is transparent allowing the trainee to study the route of wire and stent direction. In addition, the virtual radiology simulation with I-phone and HDTV allows the endoscopists to accustom its vision to black and white “x-ray” imaging, without any radiation exposure. Future evaluating the impact of this model on skills in-vivo are now being conducted.
References:
Martinek J1, Suchanek S, Stefanova M, Rotnaglova B, Zavada F, Strosova A, Zavoral M. Training on an ex vivo animal model improves endoscopic skills: a randomized, single-blind study Gastrointest Endosc Aug;74(2): doi: /j.gie
Leung JW1, Yen D. ERCP training - the potential role of simulation practice. J Interv Gastroenterol Jan;1(1):14-18.
Institutions:
1) Division of Digestive Endoscopy, Hospital Sirio Libanes, Sao Paulo, Brazil
2) Basil I. Hirschowitz Endoscopic Center of Excellence, Unit for Experimental Endoscopy and Advanced Endoscopy Training, Division of Gastroenterology and Hepatology, Universit of Alabama at Birmingham, Alabama, USA;
CONTACT:
MARCO A. D’ASSUNCAO:
Disclosure of interest: the authors declare that they have no competing interests