Su1353 Endoscopic Porcine Model of Biliary Obstruction Using Over-the-Scope Clips: Feasibility and Applicability to Training in EUS-Guided Drainage Procedures

Alcaide, Noelia; Lorenzo-Pelayo, Sara; Ruiz-Zorrilla, Rafael; Urbano, Víctor Aguilar; Val, L Sancho del; Vargas, Alba L.; Peñas, I; Serna, Carlos De La; Pérez-Miranda, Manuel

doi:10.1016/j.gie.2013.03.1006

Cited by 6 publications

(3 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Separate models have been described for individual procedures like EUS-FNB, EUS-PSD and EUS-BD. [3,4,[7][8][9][10][11][12] We are not aware of any model for EUS-GE. We have previously published our experience with a 3D-printed BD model, which appears suitable for teaching the essential basics of EUS-BD [3].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

View full text Add to dashboard Cite

show abstract

“…[ 6 ] Some in vivo swine biliary dilatation models have been described, but they provide irregular biliary dilatation and can be technically cumbersome. [ 7 8 9 10 11 12 13 ]…”

Section: Introductionmentioning

confidence: 99%

Novel swine biliary dilatation model with temperature-controlled endobiliary radiofrequency ablation: An effective tool for training in EUS-guided biliary drainage

Oh¹,

Ligresti²,

Seo³

2020

Endosc Ultrasound

View full text Add to dashboard Cite

Background and Objectives: EUS-guided biliary drainage (EUS-BD) is used as a rescue method after failed endoscopic retrograde cholangiography. However, it is considered a technically challenging procedure. Phantoms and ex vivo biliary dilatation models have been used to enhance the learning of EUS-BD, but they provide a limited level of realism. The aim of this study was to develop a swine biliary dilatation model that uses temperature-controlled endobiliary radiofrequency ablation (EB-RFA) for training in EUS-BD. Materials and Methods: Target temperature-controlled (80°C at 7 or 10 W for 60–120 s) EB-RFA was performed on seven pigs. Two weeks after the EB-RFA, EUS examination was performed to confirm biliary dilatation, and EUS-BD was then attempted by performing a hepaticogastrostomy (HGS) or cholecystogastrostomy (CGS). Results: Twelve sessions of EB-RFA (11 at the distal common bile duct [CBD] and one at the proximal CBD) were successfully performed on the seven pigs. There were no immediate postprocedural adverse events. Two weeks after the procedures, clinical signs of jaundice were observed in all the pigs. EUS examination revealed massive intrahepatic and extrahepatic biliary dilatations in all the pigs, and EUS-BD was attempted in the same session. HGS was performed on six pigs. Technical success was achieved in five of the six pigs (83.3%). Technical failure in HGS occurred during the stent deployment, and CGS was successfully performed on one pig. Conclusions: Our study shows that EB-RFA is an effective minimally invasive method for creating biliary dilatation models. It may be considered suitable for training in EUS-BD.

show abstract

“…It should recreate difficulties encountered during real life situations in human patients. Training on pig models has been attempted, but there are issues with erratic dilation of the biliary system after clipping or ligating the papilla 5 . We have previously described a 3D prototype of the bile duct, which works well for the essential steps of EUS-BD, but it does not have an attached stomach or duodenum, and thus does not simulate real life situations 6 .…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2017

Self Cite

View full text Add to dashboard Cite

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.

show abstract

Su1353 Endoscopic Porcine Model of Biliary Obstruction Using Over-the-Scope Clips: Feasibility and Applicability to Training in EUS-Guided Drainage Procedures

Cited by 6 publications

References 0 publications

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

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

Novel swine biliary dilatation model with temperature-controlled endobiliary radiofrequency ablation: An effective tool for training in EUS-guided biliary drainage

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

Contact Info

Product

Resources

About