Evaluation of an all-in-one hybrid model (EUS Magic Box) for stepwise teaching and training in multiple interventional EUS procedures

Abstract

Background and study aims While multiple interventional endoscopic ultrasound (EUS)-guided procedures have evolved over the past two decades, there is no model that allows for training in all of these procedures. We aimed to develop and validate an all-in-one hybrid model for stepwise learning in multiple EUS interventions. Methods A hybrid model was created utilizing a pig esophagus and stomach, a silicon-based duodenum and pancreato-biliary system, a pseudocyst, and biopsy targets. This model was designed to provide hands-on training in multiple interventional EUS procedures, such as EUS-guided fine-needle biopsy (EUS-FNB), biliary drainage (BD), pancreatic duct drainage (PD), pseudocyst drainage (PSD), and gastro-enterostomy (GE). Thirty-six trainees underwent training on this model over 6 days, in two batches. Lumen apposing metal stents were used for PSD and GE. Trainees were assessed for objective criteria of technical difficulties. Subjective assessment by trainees was done via a questionnaire. Results All the trainees were able to complete the requisite steps for all the procedures under supervision. On subjective assessment, 30 trainees (83 %) graded the model as good or excellent. A total of 107 technical difficulties were noted (scope position 55, duct puncture 27, guidewire-related problems 25). Time taken to complete the requisite steps of biopsy, PSD, and GE (10.5 minutes; range 3.5 to 22) was significantly less than that for BD and PD (28 minutes; range 17 to 40) (P < 0.001). Conclusions The hybrid model provided training for multiple EUS interventions with good acceptance by trainees. Stepwise mentoring with the possibility of performing multiple procedures in a single model with or without X-ray could prove useful in conference as well as institutional settings.

Revolution of hands-on model for interventional EUS: How to make a training model

“…Recently, a hybrid tissue model that allows training for multiple EUS intervention procedures, such as EUS-guided fine-needle biopsy, BD, pancreatic duct drainage, pseudocyst drainage, and gastroenterostomy, has been developed. [ 19 ] This model, the so-called EUS Magic Box, is the first model to allow multiple training within a single model. A video camera is used to replace the fluoroscopy.…”

“…The procedure feasibility and evaluation of new equipment were performed in live pigs. [ 22 – 24 ] For the training of the procedure, so far there has been only one ex vivo tissue model, the EUS Magic Box, which provides the hands-on gastroenteric procedure along with other EUS-guided intervention procedures [ 19 ] [Figure 6 ]. This model provided a pig stomach that is placed next to the duodenum made from silicone tube.…”

“…In a model that utilizes porcine tissue, only the endoscopic view and the echoendoscopic images can be seen, and fluoroscopy is necessary to visualize the guidewire or other instruments. [ 9 , 19 , 28 ] The newly developed hybrid model provides the overhead projector, which enables the user to see the tip of the guidewire and the instruments to obviate the use for fluoroscopy. [ 19 ] For a nontissue model, [ 29 ] the synthetic bile duct is made of a transparent tube so that the instrument can be seen using the overhead projector instead of fluoroscopy.…”

“…[ 9 , 19 , 28 ] The newly developed hybrid model provides the overhead projector, which enables the user to see the tip of the guidewire and the instruments to obviate the use for fluoroscopy. [ 19 ] For a nontissue model, [ 29 ] the synthetic bile duct is made of a transparent tube so that the instrument can be seen using the overhead projector instead of fluoroscopy.…”

Impact and assessment of training models in interventional endoscopic ultrasound

“…Interventional EUS procedures have shown promise in various interventions, but there needs to be a training model available for all of them. In 2022, Dhir et al 39 developed and validated a hybrid model for stepwise learning in multiple EUS interventions using the EUS Magic Box (Fig. 2).…”