title: Creation of simulated papillae for endoscopic sphincterotomy and papillectomy training by using in vivo and ex vivo pig model (with videos).
abstract: BACKGROUND
  There are few in vivo and ex vivo models for training in endoscopic sphincterotomy (ES) and endoscopic papillectomy (EP).
  
  
  OBJECTIVE
  We describe in vivo and ex vivo training pig models that use a simulated papilla for hands-on teaching of ES and EP.
  
  
  METHODS
  Animal experiment.
  
  
  METHODS
  A referral center.
  
  
  METHODS
  Hyaluronate solution (0.4%) was injected submucosally using a 25-gauge sclerotherapy needle to create a submucosal bleb by using porcine in vivo stomach, ex vivo stomach, and ex vivo rectum. ES and EP were then performed by using a pull-type sphincterotome and snare, respectively.
  
  
  METHODS
  The feasibility of creating a simulated papilla for ES and EP procedures was tested by experienced and nonexperienced ERCP endoscopists.
  
  
  RESULTS
  Creation of a hemispheroidal bulge was successful in 13 of 17 (76%) areas within an in vivo stomach, 13 of 16 (81%) areas of an ex vivo stomach, and 16 of 16 (100%) areas in an ex vivo rectum. In the in vivo stomach model, ES was successfully and realistically performed on the anterior wall of the stomach rather than in other walls. In the ex vivo stomach model, endoscopists experienced in ERCP and trainees performed ES without difficulty, whereas it was difficult or impossible for nonexperienced trainees to perform ES. In the ex vivo rectum model, all 3 endoscopists were able to complete not only ES but also EP.
  
  
  CONCLUSIONS
  Pilot study.
  
  
  CONCLUSIONS
  Although further studies are necessary to evaluate the reproducibility and cost-effectiveness, this novel pig model appears useful for ES and EP training.
authors: Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan. itoi@tokyo-med.ac.jp
authors: Takao
authors: T
authors: Itoi
authors: Takuji
authors: T
authors: Gotoda
authors: Todd H
authors: TH
authors: Baron
authors: Atsushi
authors: A
authors: Sofuni
authors: Fumihide
authors: F
authors: Itokawa
authors: Shujiro
authors: S
authors: Tsuji
authors: Takayoshi
authors: T
authors: Tsuchiya
authors: Rena
authors: R
authors: Tanaka
authors: Ryosuke
authors: R
authors: Tonozuka
authors: Mitsuyoshi
authors: M
authors: Honjo
authors: Shomei
authors: S
authors: Ryozawa
authors: Takashi
authors: T
authors: Kawai
authors: Fuminori
authors: F
authors: Moriyasu
authors: Hiroyuki
authors: H
authors: Isayama
mesh_terms: D014670:Ampulla of Vater / Q000601:surgery*; D000818:Animals; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002983:Clinical Competence; D004503:Education, Medical, Graduate / Q000379:methods*; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage; D010865:Pilot Projects; D012007:Rectum / Q000601:surgery; D016717:Sphincterotomy, Endoscopic / Q000193:education*; D013270:Stomach / Q000601:surgery; D013552:Swine
chemical_list: D006820:Hyaluronic Acid