CC BY-NC-ND 4.0 · Endosc Int Open 2017; 05(10): E1020-E1026
DOI: 10.1055/s-0043-117945
Original article
Eigentümer und Copyright ©Georg Thieme Verlag KG 2017

Comparative evaluation of two porcine ex vivo models for training in endoscopic ultrasound-guided drainage of pancreatic fluid collections

Frederick Moryoussef
1   Department of Gastroenterology, La Pitié Salpetrière Teaching Hospital, AP-HP, University Pierre et Marie Curie, Paris, France
,
Sarah Leblanc
2   Department of Gastroenterology, Cochin Teaching Hospital, AP-HP, University Paris Descartes, Sorbonne Paris Cite, Paris, France
,
Alice Bertucat
3   Life Partners Europe, 161, Avenue Gallieni, 93170 Bagnolet, France
,
Arthur Laquiere
4   Department of Gastroenterology and Hepatology, Saint Joseph Hospital, Marseille, France
,
Emmanuel Coron
5   Department of Gastroenterology and Hepatology, Nantes Teaching Hospital, Nantes, France
,
Luigi Mangialavori
2   Department of Gastroenterology, Cochin Teaching Hospital, AP-HP, University Paris Descartes, Sorbonne Paris Cite, Paris, France
,
Jean-Christophe Duchmann
6   Department of Gastroenterology and Hepatology, General Hospital of Compiegne, Compiègne, France
,
Yann Le Baleur
7   Department of Gastroenterology, Henri Mondor Teaching Hospital, AP-HP, University Paris Est Creteil, Creteil, France
,
Frederic Prat
2   Department of Gastroenterology, Cochin Teaching Hospital, AP-HP, University Paris Descartes, Sorbonne Paris Cite, Paris, France
› Author Affiliations
Further Information

Publication History

submitted 06 February 2017

accepted after revision 02 May 2017

Publication Date:
10 October 2017 (online)

Abstract

Introduction EUS-guided cystoenterostomy (EUCE), a technique used for the drainage of pancreatic pseudocysts and peri-enteric collections, requires specific skills for which dedicated models are needed. Based on a compact EASIE model (Erlangen Active Simulator for Interventional Endoscopy), we developed two ex vivo porcine models of retrogastric cysts and evaluated learning performance within the frame of a structured training program.

Material and methods The first model was made of porcine colon (i. e. “natural cyst”), the second one with an ostomy bag (i. e. “artificial cyst”). All procedures were achieved with an EUS scope under fluoroscopy. Both models were evaluated prospectively over a 2-day session involving 14 students and five experts. The primary end point was overall satisfaction with each model.

Results The “natural cyst” and “artificial cyst” were prepared within 10 and 16.5 minutes (P = 0.78), respectively. Model grading showed a non-significant trend for overall satisfaction in favor of the artificial model (P = 0.06). As secondary end points, difference was not significant for impression of realism (P = 0.75) whereas the “artificial cyst” was graded significantly better by experts and students in terms of ability to teach procedural steps (P = 0.01) and ease of puncture (P = 0.03). Moreover, experts considered the ability to improve students’ proficiency to be superior with the “artificial cyst” (P = 0.008).

Conclusion Both “artificial” and “natural cysts” are efficient for EUCE training in terms of overall satisfaction. However, the “artificial cyst” model appears to make the procedure easier with a higher ability to teach procedural steps and improve the students’ proficiency. Larger applications of this model are needed to validate as a standard of training.

 
  • References

  • 1 Andersson B, Nilsson E, Willner J. et al. Treatment and outcome in pancreatic pseudocysts. Scand J Gastroenterol 2006; 41: 751-756
  • 2 Aghdassi A, Mayerle J, Kraft M. et al. Diagnosis and treatment of pancreatic pseudocysts in chronic pancreatitis. Pancreas 2008; 36: 105-112
  • 3 Fabbri C, Luigiano C, Maimone A. et al. Endoscopic ultrasound-guided drainage of pancreatic fluid collections. World J Gastrointest Endosc 2012; 4: 479-488
  • 4 Ulla-Rocha JL, Vilar-Cao Z, Sardina-Ferreiro R. EUS-guided drainage and stent placement for postoperative intra-abdominal and pelvic fluid collections in oncological surgery. Ther Adv Gastroenterol 2012; 5: 95-102
  • 5 Varadarajulu S, Tamhane A, Blakely J. Graded dilation technique for EUS-guided drainage of peripancreatic fluid collections: an assessment of outcomes and complications and technical proficiency (with video). Gastrointest Endosc 2008; 68: 656-666
  • 6 Ng PY, Rasmussen DN, Vilmann P. et al. Endoscopic ultrasound-guided drainage of pancreatic pseudocysts: medium-term assessment of outcomes and complications. Endosc Ultrasound 2013; 2: 199-203
  • 7 Schöfl R, Buchmeier B, Hauder G. Adaptation of the Erlangen Active Simulator for Interventional Endoscopy (EASIE) model for transmural pancreatic pseudocyst drainage. Endoscopy 2006; 38: 100
  • 8 Hochberger J, Euler K, Naegel A. et al. The compact Erlangen Active Simulator for Interventional Endoscopy: a prospective comparison in structured team-training courses on “endoscopic hemostasis” for doctors and nurses to the “Endo-Trainer” model. Scand J Gastroenterol 2004; 39: 895-902
  • 9 Maiss J, Wiesnet J, Proeschel A. et al. Objective benefit of a 1-day training course in endoscopic hemostasis using the “compactEASIE” endoscopy simulator. Endoscopy 2005; 37: 552-558
  • 10 Maiss J, Prat F, Wiesnet J. et al. The complementary Erlangen active simulator for interventional endoscopy training is superior to solely clinical education in endoscopic hemostasis – the French training project: a prospective trial. Eur J Gastroenterol Hepatol 2006; 18: 1217-1225
  • 11 Baron TH, DeSimio TM. New ex-vivo porcine model for endoscopic ultrasound-guided training in transmural puncture and drainage of pancreatic cysts and fluid collections (with videos). Endosc Ultrasound 2015; 4: 34-39