Introduction Endoscopic retrograde cholangio‐pancreatography (ERCP) has higher rates of morbidity and mortality compared to upper or lower gastrointestinal tract endoscopy. The availability of magnetic resonance cholangiopancreatography means ERCP is usually performed for therapeutic purposes. Simulation could provide an adjunct to patient‐based training in ERCP however models to date have been unconvincing. Methods This ERCP simulation model was constructed from moulded meshed silicone by co‐designers: Jean Wong and Kai Cheng. The anatomical orientation was based on a combination of anatomical specimens, sectional atlases, and the clinical experience of expert endoscopists. Results From March to October 2022, we recruited 5 surgeons/gastroenterologists to the expert group and 14 medical students, junior doctors, or surgical/gastroenterological trainees to the novice group. Most experts either agreed or strongly agreed that the simulation anatomy appearance (100%), anatomical orientation (83%), tactile feedback (66%), traversal actions (67%), cannula positioning (66%) and papilla cannulation (67%) resembled the procedure in humans. Experts statistically significantly outperformed novices in obtaining a cannulating position (80% vs. 14%, P = 0.006) and successful papilla cannulation (80% vs. 7%, P = 0.0015) on their first attempt. The novice group had statistically significant improvements in time to obtaining a cannulating position (3.53 vs. 11.5 min, P = 0.006) and passing the duodenoscope to the papilla (2.55 vs. 4 passes, P = 0.009). Conclusions The simulator showed statistically significant results in face, content, and construct validity. A follow‐up validation study should recruit participants across multiple institutions. External validity could be assessed by comparing expert proceduralist simulator performance against clinical ERCP performance.

Introduction: Acute perforation of gastric remnants after single anastomosis gastric bypass are scarcely reported in the literature. The leak of gastrointestinal contents into the abdomen increases morbidity and if not promptly recognized can lead to mortality from sepsis. Case Report: A 42-year-old male developed abdominal pain and fever after laparoscopic removal of adjustable gastric band, hiatus hernia repair, and single anastomosis gastric bypass. Computed tomography showed evidence of viscus perforation, bowel obstruction, and intra-abdominal infection. Operative findings suggested bowel obstruction of the afferent small bowel loop led to perforation at the gastric remnant staple line which was repaired primarily. Conclusion: Patients presenting with early sepsis after single anastomosis gastric bypass should be investigated with computed tomography. Gastrointestinal leaks should be promptly addressed with surgical washout, primary repair, and suture reinforcement.

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