Leung Joseph W, Wang Dong, Hu Bing, Lim Brian, Leung Felix W
Gastroenterology, Sacramento VA Medical Center, VANCHCS, Mather and U C Davis Medical Center, Sacramento, CA, USA.
J Interv Gastroenterol. 2011 Jul;1(3):108-113. doi: 10.4161/jig.1.3.18509. Epub 2011 Jul 1.
ERCP mechanical simulator (EMS) and ex-vivo porcine stomach model (PSM) have been described. No direct comparison was reported on endoscopists' perception regarding their efficacy for ERCP training OBJECTIVE: Comparative assessment of EMS and PSM. DESIGN: Questionnaire survey before and after practice. SETTING: Hands-on practice workshops. SUBJECTS: 22 endoscopists with prior experience in 111±225 (mean±SD) ERCP. INTERVENTIONS: Participants performed scope insertion, selective bile duct cannulation with guide wire and insertion of a single biliary stent. Simulated fluoroscopy with external pin-hole camera (EMS), or with additional transillumination (PSM) was used to monitor exchange of accessories. MAIN OUTCOME MEASURE: Participants rated their understanding and confidence before and after hands-on practice, and credibility of each simulator for ERCP training. Comparative efficacy of EMS and PSM for ERCP education was scored (1=not, 10=very) based on pre and post practice surveys: realism (tissue pliability, papilla anatomy, visual/cannulation realism, wire manipulation, simulated fluoroscopy, overall experience); usefulness (assessment of results, supplementing clinical experience, easy for trainees to learn new skills) and application (overall ease of use, prepare trainees to use real instrument and ease of incorporation into training). RESULTS: Before hands-on practice, both EMS and PSM received high scores. After practice, there was a significantly greater increase in confidence score for EMS than PSM (p<0.003). Participants found EMS more useful for training (p=0.017). LIMITATIONS: Subjective scores. CONCLUSIONS: Based on head-to-head hands-on comparison, endoscopists considered both EMS and PSM credible options for improving understanding and supplementing clinical ERCP training. EMS is more useful for basic learning.
已介绍了内镜逆行胰胆管造影术（ERCP）机械模拟器（EMS）和离体猪胃模型（PSM）。尚未有关于内镜医师对其在ERCP培训中的效果认知的直接比较报道。目的：对EMS和PSM进行比较评估。设计：实践前后的问卷调查。地点：实践操作工作坊。受试者：22名有111±225（均值±标准差）例ERCP经验的内镜医师。干预措施：参与者进行内镜插入、使用导丝进行选择性胆管插管以及插入单个胆管支架。使用带有外部针孔摄像头的模拟荧光透视（EMS）或额外的透照（PSM）来监测附件的更换。主要观察指标：参与者在实践前后对自身理解和信心进行评分，以及对每种模拟器在ERCP培训中的可信度进行评分。根据实践前后的调查，对EMS和PSM在ERCP教育中的比较效果进行评分（1=否，10=非常）：逼真度（组织柔韧性、乳头解剖结构、视觉/插管逼真度、导丝操作、模拟荧光透视、总体体验）；有用性（结果评估、补充临床经验、便于学员学习新技能）和适用性（总体易用性、使学员准备好使用真实器械以及便于纳入培训）。结果：在实践前，EMS和PSM均获得高分。实践后，EMS的信心评分增幅显著大于PSM（p<0.003）。参与者发现EMS对培训更有用（p=0.017）。局限性：主观评分。结论：基于直接的实践比较，内镜医师认为EMS和PSM都是提高理解和补充临床ERCP培训的可靠选择。EMS对基础学习更有用。
