Download PDF
CC BY-NC-ND 4.0 · Endosc Int Open 2017; 05(11): E1087-E1095
DOI: 10.1055/s-0043-118097
Original article
Eigentümer und Copyright ©Georg Thieme Verlag KG 2017

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

Vinay Dhir
1   Baldota Institute of Digestive Sciences – Endoscopy and Endosonography, Global Hospitals, Parel, Mumbai, India
,
Takao Itoi
2   Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
,
Nonthalee Pausawasdi
3   Mahidol University Faculty of Medicine, Siriraj Hospital, Bangkok, Thailand
,
Mouen A. Khashab
4   Johns Hopkins Hospital – Gastroenterology, Baltimore, MD, USA
,
Manuel Perez-Miranda
5   Hospital Universitario Rio Hortega – Gastroenterology, Valladolid, Spain
,
Siyu Sun
6   Medicine, Sheng Jing Hospital, Liaoning, China
,
Do Hyun Park
7   Asan Medical Center – Gastroenterology, University of Ulsan, Seoul, Republic of Korea
,
Takuji Iwashita
8   Internal Medicine, Gifu University, Gifu, Japan
,
Anthony Y. B. Teoh
9   The Chinese University of Hong Kong – Surgery, Prince of Wales Hospital, Shatin, Hong Kong, China
,
Amit P. Maydeo
10   Digestive Diseases Center, Baldota Institute of Digestive Sciences, Global Hospitals, Parel, Mumbai, India
,
Khek Yu Ho
11   Department of Gastroenterology and Hepatology, National University Health System, Singapore, Singapore
› Author Affiliations
Further Information

Publication History

submitted 22 April 2017

accepted after revision 10 July 2017

Publication Date:
27 October 2017 (online)

Also available at
   Permissions and Reprints

Abstract

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.

Methods 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.

Results 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.

Conclusions 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.

 

  • References

  • 1 Dhir V, Isayama H, Itoi T. et al. EUS-guided biliary and pancreatic duct interventions. Dig Endosc 2017; 29: 472-485
    CrossrefPubMedGoogle Scholar
  • 2 Hara K, Yamao K, Mizuno N. et al. Endoscopic ultrasonography-guided biliary drainage: Who, when, which, and how?. World J Gastroenterol 2016; 22: 1297-1303
    CrossrefPubMedGoogle Scholar
  • 3 Holt BA, Hawes R, Hasan M. et al. Biliary drainage: role of EUS guidance. Gastrointest Endosc 2016; 83: 160-165
    CrossrefPubMedGoogle Scholar
  • 4 Tonozuka R, Itoi T, Tsuchiya T. et al. EUS-guided biliary drainage is infrequently used even in high-volume centers of interventional EUS. Gastrointest Endosc 2016; 84: 206-207
    CrossrefPubMedGoogle Scholar
  • 5 Alcaide N, Lorenzo-Pelayo S, Ruiz-Zorrilla R. et al. Endoscopic porcine model of biliary obstruction using over-the-scope clips: Feasibility and applicability to training in EUS-guided drainage procedures. Gastrointest Endosc 2013; 77: AB294-AB295
    CrossrefPubMedGoogle Scholar
  • 6 Dhir V, Itoi T, Fockens P. et al. Novel ex vivo model for hands-on teaching of and training in EUS-guided biliary drainage: creation of “Mumbai EUS” stereolithography/3D printing bile duct prototype (with videos). Gastrointest Endosc 2015; 81: 440-446
    CrossrefPubMedGoogle Scholar
  • 7 Artifon EL, Aparachio D, Paione JB. et al. Biliary drainage in patients with unresectable malignant obstruction where ERCP fails: endoscopic ultrasonography-guided versus percutaneous drainage. J Clin Gastroenterol 2012; 46: 768-774
    CrossrefPubMedGoogle Scholar
  • 8 Lee TH, Choi JH, Park DH. et al. Similar efficacies of endoscopic ultrasound-guided transmural and percutaneous drainage for malignant distal biliary obstruction. Clin Gastroenterol Hepatol 2016; 14: 1011-1019
    CrossrefPubMedGoogle Scholar
  • 9 Fornage B. A simple phantom for training in ultrasound-guided needle biopsy using the freehand technique. J Ultrasound Med 1989; 8: 701
    CrossrefPubMedGoogle Scholar
  • 10 Dhir V, Itoi T, Khashab MA. et al. Multicenter comparative evaluation of endoscopic placement of expandable metal stents for malignant distal common bile duct obstruction by ERCP or EUS-guided approach. Gastrointest Endosc 2015; 81: 913-923
    CrossrefPubMedGoogle Scholar
  • 11 Sharaiha RZ, Kumta NA, Desai AP. et al. Endoscopic ultrasound guided biliary drainage versus percutaneous transhepatic biliary drainage: predictors of successful outcome in patients who fail endoscopic retrograde cholangiopancreatography. Surg Endosc 2016; 30: 5500-5505
    CrossrefPubMedGoogle Scholar