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CC BY-NC-ND 4.0 · Endosc Int Open 2017; 05(11): E1087-E1095
DOI: 10.1055/s-0043-118097
Original article
Eigentümer und Copyright ©Georg Thieme Verlag KG 2017

Evaluation of a novel, hybrid model (Mumbai EUS II) for stepwise teaching and training in EUS-guided biliary drainage and rendezvous procedures

Vinay Dhir
1   Baldota Institute of Digestive Sciences – Endoscopy and Endosonography, Global Hospitals, Parel, Mumbai, India
,
Takao Itoi
2   Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
,
Nonthalee Pausawasdi
3   Mahidol University Faculty of Medicine, Siriraj Hospital, Bangkok, Thailand
,
Mouen A. Khashab
4   Johns Hopkins Hospital – Gastroenterology, Baltimore, MD, USA
,
Manuel Perez-Miranda
5   Hospital Universitario Rio Hortega – Gastroenterology, Valladolid, Spain
,
Siyu Sun
6   Medicine, Sheng Jing Hospital, Liaoning, China
,
Do Hyun Park
7   Asan Medical Center – Gastroenterology, University of Ulsan, Seoul, Republic of Korea
,
Takuji Iwashita
8   Internal Medicine, Gifu University, Gifu, Japan
,
Anthony Y. B. Teoh
9   The Chinese University of Hong Kong – Surgery, Prince of Wales Hospital, Shatin, Hong Kong, China
,
Amit P. Maydeo
10   Digestive Diseases Center, Baldota Institute of Digestive Sciences, Global Hospitals, Parel, Mumbai, India
,
Khek Yu Ho
11   Department of Gastroenterology and Hepatology, National University Health System, Singapore, Singapore
› Author Affiliations
Further Information

Publication History

submitted 22 April 2017

accepted after revision 10 July 2017

Publication Date:
27 October 2017 (online)

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Abstract

Background and aims EUS-guided biliary drainage (EUS-BD) and rendezvous (EUS-RV) are acceptable rescue options for patients with failed endoscopic retrograde cholangiopancreatography (ERCP). However, there are limited training opportunities at most centers owing to low case volumes. The existing models do not replicate the difficulties encountered during EUS-BD. We aimed to develop and validate a model for stepwise learning of EUS-BD and EUS-RV, which replicates the actual EUS-BD procedures.

Methods A hybrid model was created utilizing pig esophagus and stomach, with a synthetic duodenum and biliary system. The model was objectively assessed on a grade of 1 – 4 by two experts. Twenty-eight trainees were given initial training with didactic lectures and live procedures. This was followed by hands-on training in EUS-BD and EUS-RV on the hybrid model. Trainees were assessed for objective criteria of technical difficulties.

Results Both the experts graded the model as very good or above for all parameters. All trainees could complete the requisite steps of EUS-BD and EUS-RV in a mean time of 11 minutes (8 – 18 minutes). Thirty-six technical difficulties were noted during the training (wrong scope position, 13; incorrect duct puncture, 12; guidewire related problems, 11). Technical difficulties peaked for EUS-RV, followed by hepaticogastrostomy (HGS) and choledochoduodenostomy (CDS) (20, 9, and 7, P = 0.001). At 10 days follow-up, nine of 28 trainees had successfully performed three EUS-RV and seven EUS-BD procedures independently.

Conclusions The Mumbai EUS II hybrid model replicates situations encountered during EUS-RV and EUS-BD. Stepwise mentoring improves the chances of success in EUS-RV and EUS-BD procedures.

 

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