Training in endoscopic retrograde cholangio-pancreatography: a critical assessment of the broad scenario of training programs and models.

Introduction: Endoscopic Retrograde Cholangio-Pancreatography (ERCP) applications are rapidly evolving toward increasingly complex therapeutic approaches alongside with technological innovations. There are no globally agreed indications on the ERCP training path, which often requires too much time and does not always guarantee adequate skills.Areas covered: Frequency and difficulty of execution are the main objective criteria on which to draw up a training program: novel trainees should approach ERCP first through the simplest and most frequent procedures. An extensive use of training models would reduce the patient's performer-related risks. Amongst a wide variety of models, mechanical simulators have received large approval. In fact, they can be best-suited to each trainee's learning curve thanks to their precision and safety and by virtue of the unlimited repeatability of their use. However, more solid evidences are still needed.Expert opinion: Hands-on ERCP training should systematically employ mechanical simulators at least in the early stages of the learning process. An implementation of these models through sensors that objectively detect abnormalities in the movements would provide detailed feedbacks and deeper awareness. Simulators might also be useful for expert endoscopists to refine their skills. Rapid prototyping and 3D printing might be the way to create customized training models for successful training programs.

Endoscopes used in positive and critically ill patients are SARS-CoV-2 negative at virological assessment.

The risk of SARS-CoV-2 transmission in endoscopy is not only between patients and endoscopy staff but is also through inadequately reprocessed endoscopes. There are no studies that could confirm the efficacy of current ways of endoscope reprocessing on the elimination of SARS-CoV-2. The aim of this pilot study was to evaluate the efficacy of high disinfection of endoscopes with peracetic acid on eliminating SARS-CoV-2, but surprisingly we found that the virus cannot be detected on any part of endoscopes used in critically ill patients due to SARS-CoV-2 and this was the same for all types of endoscopies and procedures. If confirmed in larger studies, these findings will probably open a new scenario in the overall understanding of the real impact of the virus.