Jirapinyo Pichamol, Thompson Andrew C, Aihara Hiroyuki, Ryou Marvin, Thompson Christopher C
Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, MA, USA.
Harvard Medical School, Boston, MA, USA.
Clin Endosc. 2020 May;53(3):346-354. doi: 10.5946/ce.2019.105. Epub 2020 Feb 17.
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.
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.
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).
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.
背景/目的：内镜逆行胰胆管造影术（ERCP）需要一套独特的技能。目前，尚无客观的方法来评估和培训专业人员进行ERCP操作。本研究旨在开发并验证一种新型的ERCP模拟器。
该模拟器由呈现不同解剖结构且位于不同位置的乳头组成。先进行胰管的深部插管，随后进行胆管插管。规定时间为5分钟。计算了逼真度、相关性和代表性的内容效度指数（CVI）。确定了ERCP经验与模拟器评分之间的相关性。
23名参与者完成了模拟。逼真度的CVI为十二指肠镜与乳头的定向（1.00）、用于插管的乳头切开刀的角度（0.71）以及插管过程中的触觉反馈（0.80）。相关性的CVI为使用抬举器（1.00）、用于实现正面定向的转轮（1.00）以及用于选择性插管的乳头切开刀（1.00）。关于代表性的CVI，结果如下：基本插管（0.83）、乳头位置（0.83）和乳头解剖结构（0.80）。新手组、中级组和经验丰富组的得分分别为6.7±8.7、30.0±16.3和74.4±43.9（p<0.0001）。ERCP经验水平与个人模拟器评分之间存在强相关性（Pearson值为0.77，R2为0.60）。
该模拟器似乎逼真、相关且能代表ERCP插管技术。此外，它通过根据临床经验区分分数，能有效地客观评估基本的ERCP技能。
