Abstract
Background:
Endoscopic ultrasound-guided biliary drainage (EUS-BD) is an acceptable rescue option in patients with failed endoscopic retrograde cholangiopancreatography (ERCP). EUS-guided biliary rendezvous (EUS-RV) allows transpapillary drainage in patients with failed ERCP and approachable papilla. There are limited learning and training opportunities for EUS-guided biliary drainage (EUS-BD) and EUS-RV at most centers due to low case volumes. An effective and easily reproducible model is desirable
Objectives:
To develop and validate a model for stepwise learning of EUS-BD and EUS-RV.
Methods:
A hybrid model was created utilizing pig esophagus and stomach, synthetic duodenum, and synthetic biliary system with distal stricture. Twenty-eight trainees were given hands-on training in EUS-BD and EUS-RV procedures. They were assessed for objective criteria (needle puncture, contrast injection, and guidewire manipulation across hilar bifurcation, stricture, and papilla, followed by guidewire retrieval with snare into the duodenoscope channel and stent placement).
Results:
All trainees could complete the requisite steps of EUS-BD and EUS-RV in a mean time of 11 min (8–18 min). Twenty trainees had technical issues during the procedures, which were corrected by the expert (wrong scope position 4, incorrect duct puncture 8, guidewire manipulation 8). At 10 days follow-up, 9 of 28 trainees had successfully performed three EUS-RV and seven EUS-BD procedures independently at their respective institutes.
Conclusions:
The Mumbai EUS II hybrid model gives real-life feel of situations encountered during EUS-RV and EUS-BD.