Teles de Campos Sara, Boškoski Ivo, Voiosu Theodor, Salmon Maurine, Costamagna Guido, Langers Alexandra, van Hooft Jeanin E, Vanbiervliet Geoffroy, Gomercic Cécile, Lemmers Arnaud, Fockens Paul, Voermans Rogier P, Barthet Marc, Gonzalez Jean-Michel, Laleman Wim, Tarantino Ilaria, Poley Jan Werner, de Ridder Rogier, Conchillo José M, Bruno Marco J, de Jonge Pieter J F, Devière Jacques, Arvanitakis Marianna
Gastroenterology Department, Digestive Unit, Champalimaud Foundation, Lisbon, Portugal.
Gastroenterology, Université Libre de Bruxelles, Brussels, Belgium.
Endoscopy. 2025 Mar;57(3):230-239. doi: 10.1055/a-2443-6582. Epub 2024 Nov 14.
Achieving competence in endoscopic retrograde cholangiopancreatography (ERCP) requires extensive training. Recognizing the potential of simulator-based education for safe and effective skill development, we aimed to assess whether initial training with the Boškoski-Costamagna ERCP Trainer (BCT) is beneficial compared with conventional training alone (i.e. predictive validity).
A prospective multicenter randomized trial involving 16 novice ERCP trainees, randomly assigned to intervention or control groups, was performed. Both underwent hands-on training, with the intervention group receiving additional simulation training during the first 3 months. Each trainee was required to complete a minimum of 60 ERCPs in up to 1 year. The TEESAT score evaluated rates of global overall competence (primary outcome), biliary cannulation, and adverse events (AEs; secondary outcomes). Mixed-effect logistic regression models assessed differences in between-group ERCP procedure competence and success. Learning curves were generated cumulatively over the training period.
1106 ERCPs (562 simulator group; 544 control group) were included. Although no statistically significant difference in global overall competence was observed between the groups, possibly owing to data heterogeneity, simulation training demonstrated higher success for native biliary cannulation (52% vs. 42%; <0.001) and faster median (interquartile range) biliary cannulation times (3 [6] vs. 5 [8] minutes; <0.001). The simulator group also showed faster improvements in overall performance, native biliary cannulation, and sphincterotomy. No statistical difference was found in overall AEs between the groups.
Early simulation training with the BCT improved technical competence in native biliary cannulation and accelerated overall ERCP learning. This approach has the potential to enhance ERCP training programs.
