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Endoscopy 2020; 52(11): 1004-1013
DOI: 10.1055/a-1217-6727
Original article

Impact of mechanical simulator practice on clinical ERCP performance by novice surgical trainees: a randomized controlled trial

Wenbo Meng‡   *
1   Department of Special Minimally Invasive Surgery, The First Hospital of Lanzhou University, Lanzhou, China
2   Hepatopancreatobiliary Surgery Institute of Gansu Province, Clinical Medical College Cancer Center of Lanzhou University, Lanzhou, China
,
Ping Yue‡   *
1   Department of Special Minimally Invasive Surgery, The First Hospital of Lanzhou University, Lanzhou, China
2   Hepatopancreatobiliary Surgery Institute of Gansu Province, Clinical Medical College Cancer Center of Lanzhou University, Lanzhou, China
,
Joseph W. Leung
3   Department of Gastroenterology, Sacramento VA Medical Center, Mather, California, United States
4   Department of Gastroenterology and Hepatology, UC Davis Medical Center, Sacramento, California, United States
,
Haiping Wang
2   Hepatopancreatobiliary Surgery Institute of Gansu Province, Clinical Medical College Cancer Center of Lanzhou University, Lanzhou, China
5   The Second Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, China
,
Xiyan Wang
2   Hepatopancreatobiliary Surgery Institute of Gansu Province, Clinical Medical College Cancer Center of Lanzhou University, Lanzhou, China
5   The Second Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, China
,
Fangzhao Wang
2   Hepatopancreatobiliary Surgery Institute of Gansu Province, Clinical Medical College Cancer Center of Lanzhou University, Lanzhou, China
5   The Second Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, China
,
Kexiang Zhu
2   Hepatopancreatobiliary Surgery Institute of Gansu Province, Clinical Medical College Cancer Center of Lanzhou University, Lanzhou, China
5   The Second Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, China
,
Lei Zhang
2   Hepatopancreatobiliary Surgery Institute of Gansu Province, Clinical Medical College Cancer Center of Lanzhou University, Lanzhou, China
6   The Fifth Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, China
,
Xiaoliang Zhu
2   Hepatopancreatobiliary Surgery Institute of Gansu Province, Clinical Medical College Cancer Center of Lanzhou University, Lanzhou, China
6   The Fifth Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, China
,
Zhengfeng Wang
2   Hepatopancreatobiliary Surgery Institute of Gansu Province, Clinical Medical College Cancer Center of Lanzhou University, Lanzhou, China
5   The Second Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, China
,
Hui Zhang
2   Hepatopancreatobiliary Surgery Institute of Gansu Province, Clinical Medical College Cancer Center of Lanzhou University, Lanzhou, China
5   The Second Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, China
,
Wence Zhou
2   Hepatopancreatobiliary Surgery Institute of Gansu Province, Clinical Medical College Cancer Center of Lanzhou University, Lanzhou, China
5   The Second Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, China
,
Xun Li
2   Hepatopancreatobiliary Surgery Institute of Gansu Province, Clinical Medical College Cancer Center of Lanzhou University, Lanzhou, China
6   The Fifth Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, China
› Author AffiliationsTrial Registration: ClinicalTrials.gov Registration number (trial ID): NCT02838498 Type of study: Randomized study
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Author commentary on Wenbo Meng et al.Endoscopy 2020; 52(11): v44-v44
DOI: 10.1055/a-1201-4883

Abstract

Background Lack of forward-viewing endoscopy experience impairs training in endoscopic retrograde cholangiopancreatography (ERCP). We evaluated the effect of ERCP mechanical simulator (EMS) practice on ERCP performance by surgical trainees.

Patients and methods 12 surgical trainees without endoscopy experience were randomly allocated to non-EMS (n = 6) programs or to EMS (n = 6) programs with coaching and 20 hours of supervised EMS practice. All trainees then received supervised hands-on clinical ERCP training. Trainers provided verbal instructions and hands-on assistance, and took over if cannulation was not achieved by 20 minutes. Blinded trainers rated clinical performance.

Results Each group performed 150 clinical ERCPs. Biliary cannulation success was significantly higher in the EMS vs. the non-EMS group (P = 0.006), with shorter mean times (in minutes) for intubation, cannulation, and completion (all P < 0.001). EMS trainees showed a significantly better mean performance score (P = 0.006). In multivariate analysis, after adjusting for case sequence, CBD stone, complexity, and EMS training, the effect of EMS practice on odds for successful cannulation remained highly significant (odds ratio [OR] 2.10 [95 %CI 1.46 – 3.01]). At 6 months EMS trainees still had better cannulation success vs. non-EMS controls (P = 0.045); no difference was observed after 1 year.

Conclusions EMS practice shortens the ERCP early learning curve of inexperienced surgical trainees, improves clinical success in selective biliary cannulation, and may reduce complications.

* Wenbo Meng and Ping Yue contributed equally to this work.


Supplementary material



Publication History

Received: 29 December 2019

Accepted: 06 May 2020

Article published online:
31 August 2020

© 2020. Thieme. All rights reserved.

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