Development of a novel and simple ex vivo biologic ERCP training model.

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. DESIGN: Ex vivo porcine study. SETTING: 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. MAIN OUTCOME MEASUREMENTS: 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). LIMITATIONS: Pilot study. CONCLUSION: 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.

Hemostatic effect of oxidized regenerated cellulose in an experimental gastric mucosal resection model.

BACKGROUND AND STUDY AIM: The endoscopic hemostatic therapies currently available do not always result in hemostasis of gastrointestinal bleeding. Oxidized regenerated cellulose (ORC) mesh is a widely available surgical hemostatic material. The aim of this study was to evaluate the hemostatic efficacy of ORC in experimental gastric hemorrhage after endoscopic resection. METHODS: This was a prospective, two-stage experimental, Phase I, proof-of-concept study. In Stage 1, eight gastric mucosal lesions were created in anticoagulated rabbits and treated with ORC (closed or open pores). In Stage 2, the endoscopic introduction and application of ORC mesh pieces were evaluated in a porcine model of endoscopic submucosal dissection (ESD). RESULTS: In Stage 1, hemostasis was achieved in all lesions. Hemostasis was achieved more rapidly with closed-pore than open-pore ORC (24.5 vs. 66.5 seconds) (P < 0.01). At 24 hours, all lesions showed persistent hemostasis. There were no episodes of rebleeding, complications, or mortality. In Stage 2, the endoscopic introduction of ORC pieces and application with a biopsy forceps were feasible in all ESD lesions. CONCLUSIONS: ORC was an effective hemostatic agent for bleeding lesions following mucosal resection in anticoagulated rabbits. Closed-pore ORC achieved hemostasis faster than open-pore ORC. Endoscopic introduction and release of ORC were feasible.