engleski

IMPACT OF “MOTION TRAINING” ON ACQUIRING CANNULATION SKILLS FOR NOVICE ENDOSCOPISTS TRAINING ON A VALIDATED MECHANICAL ERCP SIMULATOR: INTERIM ANALYSIS FROM A RANDOMIZED CONTROL TRIAL

ERCP training remains a sensitive issue, with current data showing that traditional training methods, based on a hands-on, master-disciple paradigm, fall short of producing competent trainees. We aimed to evaluate whether a novel approach to training might improve the learning curve for novice endoscopists training in ERCP. We conducted a multicenter randomized control trial, using a validated mechanical simulator(the Boskoski-Costamagna trainer). Trainees with no experience in ERCP were either asigned to a group undergoing standard cannulation training or a group undergoing “motion-training”, which implied performing familiar motor functions such as writing and drawing, using instruments previously unfamiliar to the trainee(e.g. duodenoscope and dedicated ERCP catheters), before undergoing standard cannulation training. All trainees were timed and graded on their performance in selective cannulation of 4 different papilla configurations, with the aid of a validated score (TEESAT). 30 trainees(13 E-motion group, 17 standard group) each performed 20 timed- cannulation attempts, for a total of 600 procedures. Successful cannulation of the bile duct was achieved in 582/600 attempts(97%), with no significant difference between the two study groups(96.2 vs. 97.6%, p=0.33). Trainees in the E-motion group had significantly lower median cannulation times compared to trainees in the standard group (35 vs 44 seconds, p=0.036). On subgroup analysis, this difference was only statistically significant in terms of the first 20 attempts(papilla type 1), with further timed cannulation attempts not differing significantly between the study groups. The overall performance assessment by the supervisor using the TEESAT score showed similar results between the two study groups (p=0.559) We concluded that “motion training” had a positive impact on cannulation time during the first stages of the training, thus having the potential to improve training in ERCP. Future studies need to establish its usefulness in supplementing current training programmes.

Endoscopic retrograde cholangiopancreatography, training, mechanical simulator, motion training, randomized control trial

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