title: A novel mechanical simulator for cannulation and sphincterotomy after Billroth II or Roux-en-Y reconstruction.
abstract: BACKGROUND
  In patients with Billroth II (B II) or Roux-en-Y anatomy, endoscopic retrograde cholangiopancreatography (ERCP) is demanding. Here, we describe a novel simulator with simulated fluoroscopy for cannulation and sphincterotomy training in such situations.
  
  
  METHODS
  A custom-made simulation system was built based upon a common chassis of a series of previously described ERCP simulators. The papilla is made out of organic material and can be cut by high frequency current. The advancement of guidewires and other instruments within transparent mock bile ducts can be viewed in the window of the simulator without the need for fluoroscopy. The ERCP B II/Roux-en-Y simulation system was first evaluated during an ERCP course.
  
  
  RESULTS
  There were no technical problems related to the novel simulator during the course. After sphincterotomy, the organic papillae could easily be exchanged within a few seconds. Overall, the novel B II/Roux-en-Y simulator achieved favorable results by trainees and expert endoscopists in all categories assessed.
  
  
  CONCLUSIONS
  The new B II/Roux-en-Y mechanical simulator is simple and practicable. A first evaluation during an ERCP course showed promising results.
authors.affiliation: II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany.
authors.forename: Eckart
authors.initials: E
authors.lastname: Frimberger
authors.affiliation: II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany; Gastrointestinal Endoscopy Unit, Kasr Alainy Hospital, Cairo University, Cairo, Egypt.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Abdelhafez
authors.affiliation: II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany.
authors.forename: Roland M
authors.initials: RM
authors.lastname: Schmid
authors.affiliation: II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: von Delius