Clin Endosc.  2020 May;53(3):346-354. 10.5946/ce.2019.105.

Validation of a Novel Endoscopic Retrograde Cholangiopancreatography Cannulation Simulator

• Jirapinyo P
• Thompson AC
• Aihara H
• Ryou M
• Thompson CC

• KMID: 2502770
• DOI: http://doi.org/10.5946/ce.2019.105

Abstract

Background/Aims
Endoscopic retrograde cholangiopancreatography (ERCP) requires a unique skill set. Currently, there is no objective methodology to assess and train a professional to perform ERCP. This study aimed to develop and validate a novel ERCP simulator.
Methods
The simulator consists of papillae presenting different anatomy and positioned in varied locations. Deep cannulation of the pancreatic duct, followed by the bile duct, was performed. The time allotted was 5 minutes. The content validity indexes (CVIs) for realism, relevance, and representativeness were calculated. Correlation between ERCP experience and simulator score was determined.
Results
Twenty-three participants completed the simulation. The CVIs for realism were orientation of duodenoscope to papilla (1.00), angulation of papillotome to achieve cannulation (0.71), and haptic feedback during cannulation (0.80). The CVIs for relevance were use of elevator (1.00), wheels to achieve en face orientation (1.00), and papillotome for selective cannulation (1.00). Regarding CVI for representativeness, the results were as follows: basic cannulation (0.83), papilla locations (0.83), and papilla anatomies (0.80). The novice, intermediate, and experienced groups scored 6.7±8.7, 30.0±16.3, and 74.4±43.9, respectively (p<0.0001). There was a strong correlation between the ERCP experience level and the individual’s simulator score (Pearson value of 0.77, R2 of 0.60).
Conclusions
This simulator appears to be realistic, relevant, and representative of ERCP cannulation techniques. Additionally, it is effective at objectively assessing basic ERCP skills by differentiating scores based on clinical experience.

Keyword

Clinical competence; Education; Endoscopic retrograde cholangiopancreatography; Endoscopy; Simulation training

Figure

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  Fig. 1. Endoscopic retrograde cholangiopancreatography Simulator. (A) Papilla in a proximal second portion of the duodenum (D2) position. (B) Papilla in a distal D2 position. (C) Papilla in a standard D2 position. (D) Papilla in a standard D2 position with a long common channel and slightly off axis. (E) Papilla in a supine position. (F) Papilla in a Billroth II and Roux-en-Y gastric bypass anatomy. For papillae 1–5, a standard sphincterotome is used for cannulation. Only operators who successfully cannulate papillae 1–5 within 5 minutes are allowed to advance to papilla 6; a standard sphincterotome (shown), a cannulation catheter, or a flexible tip cannula may be used to achieve cannulation of this bonus papilla.

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  Fig. 2. Schematic drawing of simulated papilla. Each papilla differs by the length of the common channel (X), the angle between the bile duct and the pancreatic duct (Y), and the axis of the bile duct (Z)

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  Fig. 3. Complete endoscopic retrograde cholangiopancreatography simulator and room setup.

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  Fig. 4. Correlation between endoscopic retrograde cholangiopancreatography (ERCP) experience levels and simulator scores. (A) Differentiation of ERCP simulator scores among experience levels. (B) Correlation between the number of ERCPs previously performed and simulator scores. Data presented as mean±standard error.

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  Fig. 5. Endoscopic retrograde cholangiopancreatography simulator workload as assessed by the NASA Task Load Index. *Represents statistically significant difference among the 3 groups (novice, intermediate and experienced)

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