Impact of mechanical simulator practice on clinical ERCP performance by novice surgical trainees: a randomized controlled trial.
Endoscopy
; 52(11): 1004-1013, 2020 11.
Article
em En
| MEDLINE
| ID: mdl-32869230
ABSTRACT
BACKGROUND:
Lack of forward-viewing endoscopy experience impairs training in endoscopic retrograde cholangiopancreatography (ERCP). We evaluated the effect of ERCP mechanical simulator (EMS) practice on ERCP performance by surgical trainees. PATIENTS ANDMETHODS:
12 surgical trainees without endoscopy experience were randomly allocated to non-EMS (nâ=â6) programs or to EMS (nâ=â6) programs with coaching and 20 hours of supervised EMS practice. All trainees then received supervised hands-on clinical ERCP training. Trainers provided verbal instructions and hands-on assistance, and took over if cannulation was not achieved by 20 minutes. Blinded trainers rated clinical performance.RESULTS:
Each group performed 150 clinical ERCPs. Biliary cannulation success was significantly higher in the EMS vs. the non-EMS group (Pâ=â0.006), with shorter mean times (in minutes) for intubation, cannulation, and completion (all Pâ<â0.001). EMS trainees showed a significantly better mean performance score (Pâ=â0.006). In multivariate analysis, after adjusting for case sequence, CBD stone, complexity, and EMS training, the effect of EMS practice on odds for successful cannulation remained highly significant (odds ratio [OR] 2.10 [95â%CI 1.46â-â3.01]). At 6 months EMS trainees still had better cannulation success vs. non-EMS controls (Pâ=â0.045); no difference was observed after 1 year.CONCLUSIONS:
EMS practice shortens the ERCP early learning curve of inexperienced surgical trainees, improves clinical success in selective biliary cannulation, and may reduce complications.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Colangiopancreatografia Retrógrada Endoscópica
/
Competência Clínica
Tipo de estudo:
Clinical_trials
Limite:
Humans
Idioma:
En
Ano de publicação:
2020
Tipo de documento:
Article