LEARNING ERCP WITH THE BOŠKOSKI-COSTAMAGNA MECHANICAL SIMULATOR: A SINGLE TRAINEE'S EXPERIENCE

Aims:

Obtaining sufficient competence for ERCP practice requires long training and entails some well-known risks for patients. Numerous mechanical or electronic training modules have been developed recently to enhance ERCP learning curve with interesting results. In this study we have evaluated the impact of exposure to the Boškoski-Costamagna mechanical simulator on an ERCP trainee's learning curve.

Methods:

Simulator exposure was performed in three one-hour sessions on three consecutive days. Two sessions were performed with hands-on and verbal assistance from trainer and a last session with the trainee alone. The rate of deep biliary cannulation was measured for the trainee before and after his exposure to the simulator. Attention was paid to the cannulation time and complications rate.

Results:

A total of 30 consecutive patients were included, 15 before and 15 after simulator exposure. Biliary cannulation rate was significantly higher after exposure (20.0% before exposition vs. 66.7% after, p = 0.025). In addition, biliary cannulation time was significantly lower post exposure (20.0% of cannulation in the first 7 minutes before exposition vs. 66.7% after exposition p = 0.025). No difference was observed concerning immediate adverse events (13.3% before exposition vs. 0.0% after exposition p = 0.483).

Conclusions:

ERCP trainee's exposure to the Boškoski-Costamagna mechanical simulator at the beginning of training could enhance the rate and speed of deep biliary cannulation. Larger studies with multiple trainees and more variables are still needed to better evaluate the potential promising role of this simulator on ERCP trainees’ learning curve.