Guidelines for training in diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ECRP). Society of American Gastrointestinal Endoscopic Surgeons (SAGES)

The impact of a hands-on ERCP workshop on clinical practice

BACKGROUND

Hands-on endoscopy workshops are increasingly common venues for procedure training. However, the effect of this type of training on the practices of participants is unknown. The goal of this study was to examine the changes in individual clinical practices subsequent to participation in an ERCP hands-on course.

METHODS

Forty-eight practicing pancreatobiliary endoscopists participating in a 2-day hands-on advanced ERCP course were asked to complete a 24-item survey evaluating their endoscopic practices both before and 3 months after workshop participation. The surveys evaluated monthly volume and self-confidence in performing the following procedures: diagnostic ERCP, standard sphincterotomy, needle-knife pre-cut sphincterotomy, biliary stone extraction, mechanical lithotripsy, plastic stent placement, metal stent placement, and biliary brushing for cytologic specimens.

RESULTS

Thirty-one of the 48 participants (65%) who completed both pre- and postcourse surveys form the study cohort. After the workshop, there was a significant increase in use of needle-knife pre-cut sphincterotomy in clinical practices. In addition, the post-workshop survey indicated a significant increase in confidence for procedures such standard sphincterotomy, needle-knife pre-cut sphincterotomy, stone extraction, mechanical lithotripsy, placement of metal stents, and cytology brushing. Confidence in basic diagnostic ERCP and plastic stent placement did not increase because of high initial confidence levels.

CONCLUSIONS

Participation in a hands-on course appears to increase the confidence of endoscopists in the performance of more complex interventions. However, this was only associated with increased clinical application for one technique.

A direct comparison of ERCP teaching models

BACKGROUND

Several teaching models for ERCP are now available. Live, anesthetized porcine models have been used for many years, but harvested porcine organ preparations have recently been developed, and computer-based endoscopy simulators now incorporate ERCP modules. Each has proven to be a useful educational modality, but there is no direct comparison among these models. This study compared the performance of these 3 ERCP teaching models.

METHODS

Twenty endoscopists used each ERCP training model (computer simulator, harvested porcine organ, live anesthetized pig) and then completed a survey grading the realism and performance of each model compared with performance of ERCP in patients. A rank order was established for the models relative to their realism, educational utility, ease of use, and ease of incorporation into a training program.

RESULTS

The harvested porcine organ model scored highest on indices of realism, usefulness, and performance, although this reached statistical significance only for "ease of use" (p < 0.05). Conversely, the computer simulator scored significantly lower in most realism scores, although it was felt to be the one model most easily incorporated into a training program.

CONCLUSIONS

Although each ERCP teaching model has proven to be a useful training modality, the harvested porcine organ model was felt to be the most realistic as well as the most favorable model for instruction in both basic and advanced ERCP.