Evaluation of a Modified Erlangen Simulator For Ercp (Easie-Rtm) Using Two Different Duodenoscopes

Aims Evaluation of an ERCP simulator with respect to face validity and ability to evaluate the performance of two different duodenoscopes.

Methods The EASIE-RTM is a modification of the Erlangen Active Simulator for Interventional Endoscopy (EASIE) (EndoSim, LLC, Bolton, MS, USA) with an artificial papilla (chicken heart) and a biliary tree (plastic tubes). Thirteen experienced endoscopists evaluated it using two duodenoscopes in a randomized experimental bench study. The papilla was cannulated with a sphincterotome and a guidewire. Time to reach specific anatomical landmarks and to complete deep cannulation was registered in seconds, with p<0.05 considered significant. Assessment of the model was conducted to determine face and construct validity. Duodenoscopes (with CO₂, suction and water for rinsing) were the reusable Olympus TJF-Q180V (Olympus, Shinjuku, Tokyo, Japan), and a Ambu aScopeTM Duodeno (Ambu A/S, Copenhagen, Denmark), a novel sterile, single-use duodenoscope which the endoscopists had not used before. Processors: EVIS EXERA III CV/CLV-190 (Olympus) and the aBoxTM Duodeno (Ambu).

Results In all 26 ERCPs deep cannulation was accomplished (100 %, 95 %CI: 77-100 %). Time to reach the landmarks did not differ statistically, while cannulation time was longer with the aScope Duodeno (200 vs. 123 seconds, p<0.05). Median cannulation time when the aScope was the first endoscope was 209 seconds, and 134 as the second endoscope (NS). Experienced endoscopists (>1.000 ERCPs) used 134 seconds for cannulation, compared to 217 for less experienced. This difference was not statistically significant (p >0.05), but there is a risk of a Type-II error. All participants found the model realistic with respect to appearance of the organs, navigating the endoscopes in the model, and cannulation of the papilla.

Tab. 1

TIME (sec., median) TO LANDMARKS	Olympus TJF-Q180V	Ambu aScope Duodeno
Pylorus	28	32	NS
Papilla identified	62	109	NS
Cannulation position	73	125	NS
Deep cannulation achieved	123	200	PWilcoxon <0.01

Conclusions This experimental study demonstrated face validity of the EASIE-RTM ERCP model. The simulator was assessed to be realistic and capable to discriminate between two different duodenoscopes with respect to time needed for cannulation.

Citation: Adamsen S, Højgaard Tølbøll T, Matthes K eP198 EVALUATION OF A MODIFIED ERLANGEN SIMULATOR FOR ERCP (EASIE-R) USING TWO DIFFERENT DUODENOSCOPES. Endoscopy 2021; 53: S161.

Publication History

Article published online:
19 March 2021