title: Development of a novel and simple ex vivo biologic ERCP training model.
abstract: BACKGROUND
  Training and teaching of ERCP in biologic models has gained importance over the past decade. However, many existing models are expensive, are not widely available, or rely on live animals.
  
  
  OBJECTIVE
  We describe a novel and simple ex vivo, biologic model for hands-on teaching.
  
  
  METHODS
  Ex vivo porcine study.
  
  
  METHODS
  Experimental endoscopy unit.
  
  
  METHODS
  Experimental study using a custom-made ex vivo biologic ERCP simulation model. This model contains 2 new key concepts: (1) formation of a duodenal sweep by using the porcine stomach and (2) use of multiple neo-papillae for endoscopic sphincterotomy and biliary stent placement. The papilla was re-created with chicken heart, and the bile ducts were built from chicken trachea. Endoscopic sphincterotomy was performed by using a pull-type sphincterotome. Stenting was performed with Amsterdam-type plastic stents and guidewires.
  
  
  METHODS
  The following definitions were used to evaluate the model: successful implantation of the neo-papilla, stability of the neo-papilla to the neo-duodenum, successful removal of the neo-papilla, and damage to the model. The following endoscopic endpoints were evaluated: successful cannulation, cannulation time, difficulties in positioning the papilla, quality of the biliary sphincterotomy, and prosthesis placement. Procedure-related adverse events such as perforation were also assessed.
  
  
  RESULTS
  Ten neo-papillae were consecutively used in 1 duodenalized stomach. The implantation and removal of the neo-papillae were easily and successfully accomplished in all 10 cases without any damage to the duodenalized stomach. The stability of the neo-papilla on the duodenal sweep was excellent in all cases. Cannulation, biliary sphincterotomy, and stent placement could be successfully performed in 100% of cases. There was no damage and were no technical problems with the model. There were no adverse events during endoscopy (ie, perforations, stent misplacement).
  
  
  CONCLUSIONS
  Pilot study.
  
  
  CONCLUSIONS
  Although further studies are necessary, this simple, novel ex vivo model appears useful for training in sphincterotomy and bile duct cannulation. Because the neo-papillae are interchangeable, repetitive sphincterotomies and other interventions can be performed using a single porcine model.
authors.affiliation: Instituto Nacional de Cancerología, Distrito Federal, México; Basil I. Hirschowitz Endoscopic Center of Excellence, Unit for Experimental Endoscopy and Advanced Endoscopy Training, Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Jacobo
authors.initials: J
authors.lastname: Velázquez-Aviña
authors.affiliation: Instituto Nacional de Cancerología, Distrito Federal, México.
authors.forename: Sergio
authors.initials: S
authors.lastname: Sobrino-Cossío
authors.affiliation: Instituto Nacional de Cancerología, Distrito Federal, México.
authors.forename: Carlos
authors.initials: C
authors.lastname: Chávez-Vargas
authors.affiliation: Hospital Das Clinicas, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil.
authors.forename: Marianny
authors.initials: M
authors.lastname: Sulbaran
authors.affiliation: Basil I. Hirschowitz Endoscopic Center of Excellence, Unit for Experimental Endoscopy and Advanced Endoscopy Training, Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Klaus
authors.initials: K
authors.lastname: Mönkemüller
mesh_terms: D014670:Ampulla of Vater / Q000033:anatomy & histology; D000818:Animals; D002404:Catheterization; D002645:Chickens; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003135:Common Bile Duct / Q000033:anatomy & histology; D004386:Duodenum / Q000033:anatomy & histology; D004502:Education, Medical, Continuing; D004503:Education, Medical, Graduate; D005762:Gastroenterology / Q000193:education*; D006801:Humans; D008953:Models, Anatomic; D010865:Pilot Projects; D019919:Prosthesis Implantation / Q000193:education; D016717:Sphincterotomy, Endoscopic; D015607:Stents; D013552:Swine