A simple ex vivo, biologic ERCP training model for sphincterotomy

Abstract

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

Quality in endoscopy training—the endoscopic retrograde cholangiopancreatography case

“…Still, simulation-based training cannot be considered sufficient to grant one with privileges to perform ERCP and further research is needed how to best translate technical skills acquired on models to a better clinical practice. We strongly believe that for ethical reasons all endoscopy trainee should first obtain their experience during short courses on simulation models, presumably ex vivo, especially for procedures such as stent placement, stone removal and endoscopic sphincterotomy, including needle knife incisions (20)(21)(22). There are several ERCP simulators and models for handson training more widely available than ever (21)(22)(23)(24)(25)(26), and some of them like ex vivo models are inexpensive, easy to construct and reproducible (21,22).…”

“…We strongly believe that for ethical reasons all endoscopy trainee should first obtain their experience during short courses on simulation models, presumably ex vivo, especially for procedures such as stent placement, stone removal and endoscopic sphincterotomy, including needle knife incisions (20)(21)(22). There are several ERCP simulators and models for handson training more widely available than ever (21)(22)(23)(24)(25)(26), and some of them like ex vivo models are inexpensive, easy to construct and reproducible (21,22). However, although strongly recommended by both, experts and societies, very few training programs offer simulator-based training in their core curriculum (26)(27)(28)(29).…”

An Innovative Ex-Vivo Model for Rapid Change of the Papilla for Teaching Advanced Endoscopic Retrograde Cholangiopancreatography Procedures

“…Due to these difficulties, some authors have developed models using chicken´s heart to simulate the duodenal papilla (neo papilla) 5 , 6 , 7 . But this model takes a long time to prepare, because the papilla (chicken hearts) is sutured into the porcine stomach 6 .…”

“…But this model takes a long time to prepare, because the papilla (chicken hearts) is sutured into the porcine stomach 6 . While models, like Matthes 4 , take approximately 75 min to be produced our model has some advantages.…”

Training in ERCP and EUS in the UK anno 2017

“…For example, the MADA model uses vacuum cleaner tubing to mimic the duodenum and a chicken heart serving as a ‘papilla’ 21. It allows trainees to develop skills handling a side viewer and has possibilities to perform interventions such as sphincterotomy.…”