PDF(Pubmed)
Abstract：
BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (EST) are essential skills for performing endoscopic cholangiopancreatic procedures. However, these procedures have a high incidence of adverse events, and current training predominantly relies on patient-based approaches. Herein, we aimed to develop an ERCP/EST simulator model to address the need for safer training alternatives, especially for learners with limited ERCP experience.
METHODS: The model was designed to facilitate the use of actual endoscopic devices, supporting learning objectives that align with the components of the validated Bethesda ERCP Skill Assessment Tool (BESAT). BESAT focuses on skills, such as papillary alignment, maintenance of duodenoscope position, gentle and efficient cannulation, controlled sphincterotomy in the correct trajectory, and guidewire manipulation. Thirty gastroenterology trainees used the simulator between May 2022 and March 2023, and their satisfaction was assessed using a visual analog scale (VAS) and pre- and post-training questionnaires.
RESULTS: The novel simulator model comprised a disposable duodenal papillary section, suitable for incision with an electrosurgical knife, alongside washable upper gastrointestinal tract and bile duct sections for repeated use. The duodenal papillary section enabled reproduction of a realistic endoscope position and the adverse bleeding events due to improper incisions. The bile duct section allowed for the reproduction of fluoroscopic-like images, enabling learners to practice guidewire guidance and insertion of other devices. Following training, the median VAS score reflecting the expectation for model learning significantly increased from 69.5 (interquartile range [IQR]: 55.5-76.5) to 85.5 (IQR: 78.0-92.0) (p < 0.01). All participants expressed a desire for repeated simulator training sessions.
CONCLUSIONS: This innovative simulator could serve as a practical educational tool, particularly beneficial for novices in ERCP. It could facilitate hands-on practice with actual devices, enhancing procedural fluency and understanding of precise incisions to minimize the risk of bleeding complications during EST.
METHODS: The model was designed to facilitate the use of actual endoscopic devices, supporting learning objectives that align with the components of the validated Bethesda ERCP Skill Assessment Tool (BESAT). BESAT focuses on skills, such as papillary alignment, maintenance of duodenoscope position, gentle and efficient cannulation, controlled sphincterotomy in the correct trajectory, and guidewire manipulation. Thirty gastroenterology trainees used the simulator between May 2022 and March 2023, and their satisfaction was assessed using a visual analog scale (VAS) and pre- and post-training questionnaires.
RESULTS: The novel simulator model comprised a disposable duodenal papillary section, suitable for incision with an electrosurgical knife, alongside washable upper gastrointestinal tract and bile duct sections for repeated use. The duodenal papillary section enabled reproduction of a realistic endoscope position and the adverse bleeding events due to improper incisions. The bile duct section allowed for the reproduction of fluoroscopic-like images, enabling learners to practice guidewire guidance and insertion of other devices. Following training, the median VAS score reflecting the expectation for model learning significantly increased from 69.5 (interquartile range [IQR]: 55.5-76.5) to 85.5 (IQR: 78.0-92.0) (p < 0.01). All participants expressed a desire for repeated simulator training sessions.
CONCLUSIONS: This innovative simulator could serve as a practical educational tool, particularly beneficial for novices in ERCP. It could facilitate hands-on practice with actual devices, enhancing procedural fluency and understanding of precise incisions to minimize the risk of bleeding complications during EST.
摘要：
背景：内镜逆行胰胆管造影术（ERCP）和内镜括约肌切开术（EST）是内镜胰胆管手术的基本技能。然而,这些程序的不良事件发生率很高，目前大多数培训是以病人为基础的。在这里，我们旨在开发ERCP/EST模拟器模型，以满足对更安全的培训替代方案的需求，特别是对于ERCP经验有限的学习者。
方法：该模型的设计是为了便于使用实际的内窥镜设备，支持与经过验证的BethesdaERCP技能评估工具（BESAT）组件一致的学习目标。BESAT专注于诸如乳头对准和十二指肠镜位置的维护等技能，温和而有效的插管，控制括约肌切开术在正确的轨迹，和导丝操作。在2022年5月至2023年3月之间，有30名胃肠病学学员使用了模拟器，并使用视觉模拟量表（VAS）以及培训前后的问卷评估了他们的满意度。
结果：新的模拟器模型包括一次性十二指肠乳头部分，适合用电刀切开，旁边可清洗的上消化道和胆管部分，专为重复使用而设计。十二指肠乳头部分能够再现真实的内窥镜位置以及由于切口不当而导致的不良出血事件。胆管部分允许再现类似荧光的图像，使学习者能够练习导丝引导和插入其他设备。培训后,反映模型学习期望的中位VAS评分从69.5(四分位距[IQR]:55.5-76.5)显著增加至85.5(IQR:78.0-92.0)(P<0.01).所有参与者都表示希望重复进行模拟器培训。
结论：这个创新的模拟器作为一个实用的教育工具，对ERCP新手特别有益。它有助于实际设备的动手实践，增强程序流畅性和对精确切口的理解，以最大程度地减少EST期间出血并发症的风险。
方法：该模型的设计是为了便于使用实际的内窥镜设备，支持与经过验证的BethesdaERCP技能评估工具（BESAT）组件一致的学习目标。BESAT专注于诸如乳头对准和十二指肠镜位置的维护等技能，温和而有效的插管，控制括约肌切开术在正确的轨迹，和导丝操作。在2022年5月至2023年3月之间，有30名胃肠病学学员使用了模拟器，并使用视觉模拟量表（VAS）以及培训前后的问卷评估了他们的满意度。
结果：新的模拟器模型包括一次性十二指肠乳头部分，适合用电刀切开，旁边可清洗的上消化道和胆管部分，专为重复使用而设计。十二指肠乳头部分能够再现真实的内窥镜位置以及由于切口不当而导致的不良出血事件。胆管部分允许再现类似荧光的图像，使学习者能够练习导丝引导和插入其他设备。培训后,反映模型学习期望的中位VAS评分从69.5(四分位距[IQR]:55.5-76.5)显著增加至85.5(IQR:78.0-92.0)(P<0.01).所有参与者都表示希望重复进行模拟器培训。
结论：这个创新的模拟器作为一个实用的教育工具，对ERCP新手特别有益。它有助于实际设备的动手实践，增强程序流畅性和对精确切口的理解，以最大程度地减少EST期间出血并发症的风险。
