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Benavides-Salgado DE, Jiménez-Castillo RA, Cuéllar-Monterrubio JE, Jáquez-Quintana JO, Garza-Galindo A, Cortes-Hernández C, Maldonado-Garza HJ, García-Compeán D, González-González JA. Papilla of Vater morphology as an influencing factor in successful cannulation during resident training in advanced endoscopy. A prospective clinical study. REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 2024; 89:237-242. [PMID: 37689502 DOI: 10.1016/j.rgmxen.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 05/04/2023] [Indexed: 09/11/2023]
Abstract
INTRODUCTION AND AIM Endoscopic retrograde cholangiopancreatography (ERCP) is a complex procedure. Clinical guidelines assess competence in ERCP through a defined number of procedures, but multiple factors are involved. Our aim was to analyze the morphology of the papilla of Vater as an independent factor in selective common bile duct cannulation during resident training. MATERIAL AND METHODS Patients that underwent ERCP were studied consecutively. All ERCPs were begun by a resident in training. The type of papilla was classified according to Haraldsson, including those with previous sphincterotomy. Cannulation difficulty and success and their relation to the type of papilla were documented. The analysis was divided into three 4-month periods. RESULTS Of the 429 patients, cannulation was difficult in 101 (23.5%). The residents achieved selective cannulation of the common bile duct in 276 (64.3%) and the cannulation success rate at the end of their training was 81.7%. Cannulation was performed with the least difficulty in papillae with previous sphincterotomy (2.8%), unlike the type 4 papilla, which was difficult to cannulate in 50% of the cases. The lowest overall cannulation success was in the type 2 papilla (81.8%). CONCLUSION Papilla type can influence cannulation success, but it is not the only related factor. Patients that underwent previous sphincterotomy appear to be the cases in whom ERCP training can be started.
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Affiliation(s)
- D E Benavides-Salgado
- Servicio de Gastroenterologia y Endoscopía, Hospital Universitario «Dr. E. González», Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - R A Jiménez-Castillo
- Servicio de Gastroenterologia y Endoscopía, Hospital Universitario «Dr. E. González», Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - J E Cuéllar-Monterrubio
- Servicio de Gastroenterologia y Endoscopía, Hospital Universitario «Dr. E. González», Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - J O Jáquez-Quintana
- Servicio de Gastroenterologia y Endoscopía, Hospital Universitario «Dr. E. González», Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - A Garza-Galindo
- Servicio de Gastroenterologia y Endoscopía, Hospital Universitario «Dr. E. González», Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - C Cortes-Hernández
- Servicio de Gastroenterologia y Endoscopía, Hospital Universitario «Dr. E. González», Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - H J Maldonado-Garza
- Servicio de Gastroenterologia y Endoscopía, Hospital Universitario «Dr. E. González», Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - D García-Compeán
- Servicio de Gastroenterologia y Endoscopía, Hospital Universitario «Dr. E. González», Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - J A González-González
- Servicio de Gastroenterologia y Endoscopía, Hospital Universitario «Dr. E. González», Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico.
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Georgiou K, Boyanov N, Antonakis P, Thanasas D, Sandblom G, Enochsson L. Validity of a virtual reality endoscopic retrograde cholangiopancreatography simulator: can it distinguish experts from novices? Front Surg 2023; 10:1289197. [PMID: 38125582 PMCID: PMC10731023 DOI: 10.3389/fsurg.2023.1289197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/21/2023] [Indexed: 12/23/2023] Open
Abstract
Background There is a lack of evidence regarding the effectiveness of virtual simulators as a means to acquire hands-on exposure to endoscopic retrograde cholangiopancreatography (ERCP). The present study aimed to assess the outcome and construct validity of virtual ERCP when training on the GI II Mentor simulator. Methods A group of seven experienced endoscopists were compared with 31 novices. After a short introduction, they were requested to carry out three virtual ERCP procedures: diagnosing and removing a common bile duct (CBD) stone; diagnosing and taking brush cytology from a hilar stenosis; and, finally, diagnosing and treating a cystic leakage with a BD stent. For each task, the total time required to complete the task, time required to correctly view the papilla, total time of irradiation, time to deep cannulation, time to define diagnosis, time to complete sphincterotomy, and time to complete the respective intervention were measured. Cannulation of the BD, correct diagnosis, sphincterotomy, and time to complete intervention were assessed by an assessor blinded to the status of the endoscopist who performed the virtual ERCP. Results The time required to visualize the papilla and to cannulate deeply when removing the BD stone was significantly shorter for the experts (both p < 0.05). The time to visualize the papilla, cannulate deeply, reach a diagnosis, complete sphincterotomy, and complete the intervention was significantly shorter for the experts when managing cystic leakage (all p < 0.05). In diagnosing and taking brush cytology from a hilar stenosis, there was only a trend toward the experts needing less time for the deep cannulation of the BD (p = 0.077). Conclusion The performance differed between experts and novices, especially in the management of cystic leakage. This corroborates the construct validity of the GI II Mentor simulator.
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Affiliation(s)
- Konstantinos Georgiou
- 1st Department of Propaedeutic Surgery, Hippokration General Hospital of Athens, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikola Boyanov
- Medical Simulation Training Center, Research Institute of Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Pantelis Antonakis
- 2nd Department of Surgery, Medical School, Aretaieion Hospital, National and Kapodistrian University, Athens, Greece
| | - Dimitrios Thanasas
- Medical Physics Laboratory Simulation Center, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Gabriel Sandblom
- Department of Clinical Science and Education Södersjukhuset, Department of Surgery, Södersjukhuset, Karolinska Institutet, Stockholm, Stockholm, Sweden
| | - Lars Enochsson
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
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Jeon SW. There is no royal road: a shortcut for endoscopic submucosal dissection training. Clin Endosc 2023; 56:590-591. [PMID: 37614149 PMCID: PMC10565439 DOI: 10.5946/ce.2023.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/04/2023] [Accepted: 06/05/2023] [Indexed: 08/25/2023] Open
Affiliation(s)
- Seong Woo Jeon
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
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Benavides-Salgado D, Jiménez-Castillo R, Cuéllar-Monterrubio J, Jáquez-Quintana J, Garza-Galindo A, Cortes-Hernández C, Maldonado-Garza H, García-Compeán D, González-González J. Morfología de la papila de Vater como factor que influye en el éxito en canulación durante el entrenamiento del Residente en Endoscopia Avanzada. Estudio clínico prospectivo. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2023. [DOI: 10.1016/j.rgmx.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/09/2023]
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Brodaric AM, Wong NLJ, Falon J, Wong J, Cheng K, Whereat S, Storey D. Anatomical endoscopic retrograde cholangiopancreatography simulator using moulded meshed silicone: A novel simulator pilot study. ANZ J Surg 2023; 93:1817-1824. [PMID: 37140189 DOI: 10.1111/ans.18495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 04/19/2023] [Indexed: 05/05/2023]
Abstract
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.
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Affiliation(s)
- Alen Maximillian Brodaric
- Surgery, Royal Prince Alfred Hospital, Sydney, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- RPA Institute of Academic Surgery, Sydney, Australia
| | - Ngar Lok Joshua Wong
- Surgery, Royal Prince Alfred Hospital, Sydney, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Jessica Falon
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- RPA Institute of Academic Surgery, Sydney, Australia
| | - Jean Wong
- Surgery, Royal Prince Alfred Hospital, Sydney, Australia
- RPA Institute of Academic Surgery, Sydney, Australia
| | - Kai Cheng
- RPA Institute of Academic Surgery, Sydney, Australia
| | - Sarah Whereat
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- RPA Institute of Academic Surgery, Sydney, Australia
- Sydney Education, Sydney Local Health District, Sydney, Australia
| | - David Storey
- Surgery, Royal Prince Alfred Hospital, Sydney, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- RPA Institute of Academic Surgery, Sydney, Australia
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Gallo C, Boškoski I, Matteo MV, Orlandini B, Costamagna G. Training in endoscopic retrograde cholangio-pancreatography: a critical assessment of the broad scenario of training programs and models. Expert Rev Gastroenterol Hepatol 2021; 15:675-688. [PMID: 33599177 DOI: 10.1080/17474124.2021.1886078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Endoscopic Retrograde Cholangio-Pancreatography (ERCP) applications are rapidly evolving toward increasingly complex therapeutic approaches alongside with technological innovations. There are no globally agreed indications on the ERCP training path, which often requires too much time and does not always guarantee adequate skills.Areas covered: Frequency and difficulty of execution are the main objective criteria on which to draw up a training program: novel trainees should approach ERCP first through the simplest and most frequent procedures. An extensive use of training models would reduce the patient's performer-related risks. Amongst a wide variety of models, mechanical simulators have received large approval. In fact, they can be best-suited to each trainee's learning curve thanks to their precision and safety and by virtue of the unlimited repeatability of their use. However, more solid evidences are still needed.Expert opinion: Hands-on ERCP training should systematically employ mechanical simulators at least in the early stages of the learning process. An implementation of these models through sensors that objectively detect abnormalities in the movements would provide detailed feedbacks and deeper awareness. Simulators might also be useful for expert endoscopists to refine their skills. Rapid prototyping and 3D printing might be the way to create customized training models for successful training programs.
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Affiliation(s)
- Camilla Gallo
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Centre for Endoscopic Research Therapeutics and Training (CERTT), Catholic University of Rome, Italy
| | - Ivo Boškoski
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Centre for Endoscopic Research Therapeutics and Training (CERTT), Catholic University of Rome, Italy
| | - Maria Valeria Matteo
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Centre for Endoscopic Research Therapeutics and Training (CERTT), Catholic University of Rome, Italy
| | - Beatrice Orlandini
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Centre for Endoscopic Research Therapeutics and Training (CERTT), Catholic University of Rome, Italy
| | - Guido Costamagna
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Centre for Endoscopic Research Therapeutics and Training (CERTT), Catholic University of Rome, Italy
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