title: Novel ex vivo model for hands-on teaching of and training in EUS-guided biliary drainage: creation of "Mumbai EUS" stereolithography/3D printing bile duct prototype (with videos).
abstract: BACKGROUND
  EUS-guided biliary drainage (EUS-BD) has emerged as an alternative rescue method in patients with failed ERCP. Opportunities for teaching and training are limited because of a low case volume at most centers.
  
  
  OBJECTIVE
  To evaluate a stereolithography/3-dimensional (3D) printing bile duct prototype for teaching and training in EUS-BD.
  
  
  METHODS
  Prospective observational feasibility study.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  Twenty endosonographers attending an interventional EUS workshop.
  
  
  METHODS
  A prototype of a dilated biliary system was prepared by computer-aided design and 3D printing. The study participants performed guidewire manipulation and EUS-BD procedures (antegrade procedure and/or choledochoduodenostomy) on the prototype. Participants were scored with the device on a scale of 1 to 5 via a questionnaire. Participants' success rate for various steps of the EUS-BD procedure was noted.
  
  
  METHODS
  Subjective and objective evaluation of the prototype regarding its overall applicability, quality of radiographic and EUS images, and 4 steps of EUS-BD procedure (needle puncture, guidewire manipulation, tract dilation, stent placement).
  
  
  RESULTS
  Fifteen participants returned the questionnaire, and 10 completed all 4 steps of EUS-BD. The median score for overall utility was 4, whereas that for EUS and US views was 5. Participants with experience in performing more than 20 EUS-BD procedures scored the prototype significantly lower for stent placement (P = .013) and equivalent for needle puncture, tract dilation, and wire manipulation. The success rate of various steps was 100% for needle puncture and tract dilation, 82.35% for wire manipulation, and 80% for stent placement. The mean overall procedure time was 18 minutes.
  
  
  CONCLUSIONS
  Small number of participants.
  
  
  CONCLUSIONS
  The 3D printing bile duct prototype appears suitable for teaching of and training in the various steps of EUS-BD. Further studies are required to elucidate its role.
authors.affiliation: Baldota Institute of Digestive Sciences, Mumbai, India.
authors.forename: Vinay
authors.initials: V
authors.lastname: Dhir
authors.affiliation: Tokyo Medical University, Tokyo, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Itoi
authors.affiliation: Academic medical Centre, Amsterdam, Netherlands.
authors.forename: Paul
authors.initials: P
authors.lastname: Fockens
authors.affiliation: Valladolid University Medical School, Valladolid, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Perez-Miranda
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Mouen A
authors.initials: MA
authors.lastname: Khashab
authors.affiliation: Asan Medical Center, Seoul, South Korea.
authors.forename: Dong Wan
authors.initials: DW
authors.lastname: Seo
authors.affiliation: Peking University Medical Center Hospital, Beijing, China.
authors.forename: Ai Ming
authors.initials: AM
authors.lastname: Yang
authors.affiliation: National University Health System, Singapore.
authors.forename: Khek Yu
authors.initials: KY
authors.lastname: Lawrence
authors.affiliation: Baldota Institute of Digestive Sciences, Mumbai, India.
authors.forename: Amit
authors.initials: A
authors.lastname: Maydeo
mesh_terms: D001653:Bile Ducts, Intrahepatic; D003135:Common Bile Duct; D004322:Drainage / Q000295:instrumentation / Q000379:methods; D019160:Endosonography / Q000379:methods; D004867:Equipment Design; D005240:Feasibility Studies; D005762:Gastroenterology / Q000193:education*; D006801:Humans; D008953:Models, Anatomic; D017145:Models, Educational; D011076:Polycarboxylate Cement; D066330:Printing, Three-Dimensional; D011446:Prospective Studies; D015607:Stents; D018084:Ultrasonography, Interventional / Q000379:methods; D014481:United States
chemical_list: D011076:Polycarboxylate Cement; C005506:polycarbonate