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Endosc Int Open. 2017 Nov;5(11):E1087-E1095. doi: 10.1055/s-0043-118097. Epub 2017 Oct 27.

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

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Baldota Institute of Digestive Sciences - Endoscopy and Endosonography, Global Hospitals, Parel, Mumbai, India.
Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan.
Mahidol University Faculty of Medicine, Siriraj Hospital, Bangkok, Thailand.
Johns Hopkins Hospital - Gastroenterology, Baltimore, MD, USA.
Hospital Universitario Rio Hortega - Gastroenterology, Valladolid, Spain.
Medicine, Sheng Jing Hospital, Liaoning, China.
Asan Medical Center - Gastroenterology, University of Ulsan, Seoul, Republic of Korea.
Internal Medicine, Gifu University, Gifu, Japan.
The Chinese University of Hong Kong - Surgery, Prince of Wales Hospital, Shatin, Hong Kong, China.
Digestive Diseases Center, Baldota Institute of Digestive Sciences, Global Hospitals, Parel, Mumbai, India.
Department of Gastroenterology and Hepatology, National University Health System, Singapore, Singapore.


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.


 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.


 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.


 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.

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