The Erlangen Endo-Trainer: Life-Like Simulation for Diagnostic and Interventional Endoscopic Retrograde Cholangiography

The Erlanger Endo-Trainer offers a large spectrum of training possibilities in endoscopic techniques using life-like biological specimens. We organised the first pilot study of interventions at the papilla and the bile duct under x-ray control. Specially prepared upper visceral porcine organ packages including the esophagus, stomach, duodenum, liver, gallbladder and bile ducts were implanted into the Endo-Trainer. Furthermore, small stones were introduced into the bile duct. The test study was carried out by a senior endoscopist assisted by his endoscopy nurse. The following steps could therefore be carried out as a structured team-training scheme: Introduction of the side-viewing endoscope and passage into the duodenum; identification and adjustment at the papilla; cannulation of the papilla; selective bile duct imaging with contrast application under x-ray vision; placement of a guidewire; papillotomy; stone extraction and finally placement of a plastic stent. The special value of this type of simulation is the fact that endoscopic techniques can be trained in the usual manner with real tissue-feeling using regular commercial instruments. Although there is general consent that individual practice on the patient cannot be completely replaced by simulator training, a suitable and realistic simulation model can be of great value, for initial steps prior to “real” patient contact as well as for refining techniques and tactics.

References

• 1 Classen M, Ruppin H. Practical endoscopy training using a new gastrointestinal phantom.  Endoscopy. 1974;  6 127-131
• 2 Freys M S, Heimbucher J, Fuchs K H. Teaching upper gastrointestinal endoscopy: the pig stomach.  Endoscopy. 1995;  27 73-76
• 3 Gholson C F, Provenza J M, Silver R C, Bacon B R. Endoscopic retrograde cholangiography in the swine: a new model for endoscopic training and hepatobiliary research.  Gastrointest Endosc. 1990;  36 (6) 600-603
• 4 Soehendra N, Binmoeller K F. Overview of interactive endoscopy simulators.  Endoscopy. 1992;  24 (Suppl. 1) 549-550
• 5 Bar-Meir S. Endoscopic Simulator.  Endoscopy. 2000;  32 898-900
• 6 Neumann M, Fischer B, Ell C, et al. Training and research facilities in endoscopy: the Erlangen Endo-Trainer.  Endoscopy. 2000;  32 in press
• 7 Hochberger J, Neumann M, Maiss J, et al. EASIE-Erlangen active simulator for interventional endoscopy; a new bio-simulation model; first experience gained in training workshops.  Gastrointest Endosc. 1998;  47 AB116
• 8 Rabenstein T, Schneider H T, Bullin D, et al. Analysis of risk factors associated with endoscopic sphincterotomy techniques: preliminary results of a prospective study with emphasis on the reduced risk of acute pancreatitis with low-dose anticoagulation treatment.  Endoscopy. 2000;  32 10-19
• 9 Rabenstein T, Schneider H T, Ell C. 25 years of EST in Erlangen: assessment of experience in the treatment of 3498 patients.  Endoscopy. 1998;  30 A194-A201
• 10 Rabenstein T, Schneider T, Nicklas M, et al. The impact of skill and experience of the endoscopist on the outcome of endoscopic sphincterotomy.  Gastrointest Endosc. 1999;  50 628-636
• 11 Huibregtse K. Complications of endoscopic sphincterotomy and their prevention.  N Engl J Med. 1996;  335 961-963
• 12 Cass O W, Freeman M L, Peine C J, et al. Objective evaluation of endoscopy skills during training.  Ann Intern Med. 1993;  118 40-44
• 13 Watkins J L, Etzkorn K P, Wiley T E, et al. Assessment of competence during ERCP training.  Gastrointest Endosc. 1996;  44 411-415
• 14 Friedman L S. How long does it take to learn endoscopy?.  Gastrointest Endosc. 1995;  42 371-373
• 15 Jowell P S, Baillie J, Branch M S, et al. Quantitative assessment of procedural competence: a prospective study of training in endoscopic retrograde cholangiography.  Ann Intern Med. 1996;  125 983-989
• 16 Baillie J, Jowell P. ERCP training in the 1990s: time for new ideas.  Gastrointest Endosc Clin Am. 1994;  4 409-421