Septotomy and balloon dilation were initially performed on a difficult-to-treat chronic fistula after gastric bypass and named before as stricturotomy (Campos JM, Siqueira LT, Ferraz AA, et al., J Am Coll Surg 204(4):711, 2007). This procedure allows internal drainage of the fistula and deviates oral intake to the pouch. In addition, achalasia balloon dilation treats strictures and axis deviation of the gastric chamber, promoting reduction of the intragastric pressure. Septotomy and balloon dilation are technically feasible and might be useful in selected cases for closure of chronic leaks after LSG.

No abstract

Few models are available for hands-on training in endoscopic retrograde cholangiopancreatography (ERCP). Moreover, the key aspect of learning ERCP properly is the acquisition of manual and visual skills [1, 2]. Although performing ERCP procedures in human beings eventually leads to expertise, both experts and endoscopy societies strongly encourage that some of the key skills be acquired with the use of training models [3]. Herein, we show a simple ERCP model for training endoscopists in scope insertion, wheel handling, cannulation, and stent insertion. The model consists of a metal cage, which serves to hold synthetic elements that comprise a model of the upper gastrointestinal and pancreaticobiliary tracts (• " Fig. 1,• " Video 1). The esophagus, stomach, and duodenal sweep are constructed from a plastic tube (• " Fig. 2 a). The papillae are made of latex, and the bile ducts are made of plastic. The pancreaticobiliary tree can be attached to the cage at various levels of difficulty (• " Fig. 2 b). The model was placed on a table, and ERCP was then performed by five trainees and by five endoscopists with and without ERCP experience (• " Video 1). An Olympus duodenoscope (TJF-Q180V; Olympus America, Center Valley, Pennsylvania, USA) was used. The endoscopists were filmed, observed, and guided by two ERCP

The key therapeutic intervention during endoscopic retrograde cholangiopancreatography (ERCP) is sphincterotomy, but lack of training and experience leads to a higher risk of complications [1, 2]. Herein, we present a simple, reproducible, easyto-build, ex vivo, ERCP model for the training of sphincterotomy using standard sphincterotomes and a needle knife. The model is based on incorporating one or more chicken hearts into a pig stomach (• " Fig. 1,• " Fig. 2,• " Fig. 3,• " Video 1). The native pig papilla has some limitations for sphincterotomy training, mainly because of its awkward location in the bulb compared with in the second duodenum in humans. To solve this issue, we previously created a model in which the pig stomach was "duodenalized" to resemble the duodenal sweep in humans [3]. The duodenalization overcame the common position problems when performing ERCP in intact pig stomachs, which are large and J-shaped. In a further development of

E-Videos ▶ Fig. 1 Barium contrast study of the small bowel suggesting a "windsock sign" (arrow). E65This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.