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J Interv Gastroenterol. 2011 Jul;1(3):108-113. Epub 2011 Jul 1.

A head-to-head hands-on comparison of ERCP mechanical simulator (EMS) and Ex-vivo Porcine Stomach Model (PSM).

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Gastroenterology, Sacramento VA Medical Center, VANCHCS, Mather and U C Davis Medical Center, Sacramento, CA, USA.



ERCP mechanical simulator (EMS) and ex-vivo porcine stomach model (PSM) have been described. No direct comparison was reported on endoscopists' perception regarding their efficacy for ERCP training OBJECTIVE: Comparative assessment of EMS and PSM.


Questionnaire survey before and after practice.


Hands-on practice workshops.


22 endoscopists with prior experience in 111±225 (mean±SD) ERCP.


Participants performed scope insertion, selective bile duct cannulation with guide wire and insertion of a single biliary stent. Simulated fluoroscopy with external pin-hole camera (EMS), or with additional transillumination (PSM) was used to monitor exchange of accessories.


Participants rated their understanding and confidence before and after hands-on practice, and credibility of each simulator for ERCP training. Comparative efficacy of EMS and PSM for ERCP education was scored (1=not, 10=very) based on pre and post practice surveys: realism (tissue pliability, papilla anatomy, visual/cannulation realism, wire manipulation, simulated fluoroscopy, overall experience); usefulness (assessment of results, supplementing clinical experience, easy for trainees to learn new skills) and application (overall ease of use, prepare trainees to use real instrument and ease of incorporation into training).


Before hands-on practice, both EMS and PSM received high scores. After practice, there was a significantly greater increase in confidence score for EMS than PSM (p<0.003). Participants found EMS more useful for training (p=0.017).


Subjective scores.


Based on head-to-head hands-on comparison, endoscopists considered both EMS and PSM credible options for improving understanding and supplementing clinical ERCP training. EMS is more useful for basic learning.

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