Initial validation of a simple, nonbiological, mechanical ERCP training model for cannulation and stent placement

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

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).…”

Production of ERCP training model using a 3D printing technique (with video)

“…Also, compared with the mechanical method mentioned below, computer simulators do not use real endoscopes or accessories, and have not received much response so far [27]. The mechanical methods involve artificial duodenum, ampulla, and distal bile ducts in a container, so that only some techniques such as cannulation and stent insertion can be practiced [7,28]. It is simple and portable, and it has been widely used for basic training.…”

Production of ERCP training model using a 3D printing technique (with video)

“…Also, compared with the mechanical method mentioned below, computer simulators do not use real endoscopes or accessories, and have not received much response so far [27]. The mechanical methods involve artificial duodenum, ampulla, and distal bile ducts in a container, so that only some techniques such as cannulation and stent insertion can be practiced [28,29]. It is simple and portable, and it has been widely used for basic training.…”