Background Training simulators have been used for decades with success; however, a standardized educational strategy for diagnostic EGD is still lacking. Objective Development of a training strategy ...for diagnostic upper endoscopy. Study design Prospective, randomized trial. Settings A total of 28 medical and surgical residents without endoscopic experience were enrolled. Basic skills evaluations were performed following a structured program involving theoretical lectures and a hands-on course in diagnostic EGD. Subsequently, stratified randomization to clinical plus simulator training (group 1, n = 10), clinical training only (group 2, n = 9), or simulator training only (group 3, n = 9) was performed. Ten sessions of simulator training were conducted for groups 1 and 3 during the 4-month program. Group 2 underwent standard training in endoscopy without supplemental simulator training. The final evaluation was performed on the simulator and by observation of 3 clinical cases. Skills and procedural times were recorded by blinded and unblinded evaluators. Main Outcome Measurements Time to reach the duodenum, pylorus, or esophagus. Results All trainees demonstrated a significant reduction in procedure time during a simple manual skills test ( P < .05) and significantly better skills scores ( P = .006, P = .042 and P = .017) in the simulator independent of the training strategy. Group 1 showed shorter times to intubate the esophagus (61 ± 26 seconds vs 85 ± 30 seconds and 95 ± 36 seconds) and the pylorus (183 ± 65 seconds vs 207 ± 61 seconds and 247 ± 66 seconds) during the clinical evaluation. Blinded assessment of EGD skills showed significantly better results for group 1 compared with group 3. Blinded and unblinded evaluations were not statistically different. Limitations Small sample size. Conclusions Structured simulator training supplementing clinical training in upper endoscopy appears to be superior to clinical training alone. Simulator training alone does not seem to be sufficient to improve endoscopic skills.
Background Clip application has been proven to be effective for endoscopic hemostasis. There are limited bench data on the efficacy of the over-the-scope clip (OTSC) for the treatment of spurting GI ...hemorrhage. We evaluated the hemodynamic efficacy of the OTSC in an established bleeding model. Objective To evaluate the hemodynamic efficacy of the OTSC in an established bleeding model. Design Prospective experimental trial with historical comparison. Setting We tested the OTSC prospectively in a validated bleeding model by using the compact Erlangen Active Simulator for Interventional Endoscopy equipped with an upper GI organ package. The artificial blood circulation system of the simulator was connected to an arterial pressure transducer. Two investigators with different endoscopic experience (4000 and 10,000 endoscopies performed) participated. Each investigator treated 16 bleeding sites in the simulator with the OTSC by using only suction (n = 8) and a novel retraction device to grasp tissue (n = 8). Systemic pressures were recorded 1 minute before, during, and 1 minute after clip application to objectify the effects of clipping on the vessel diameter. Main Outcome Measurements Mean and maximum reduction in vessel diameter. Results The application of the OTSC on the bleeding vessel led to a significant increase in systemic pressure ( P < .001) and decreased vessel diameter ( P < .001) independent of the endoscopic experience of the investigator. There was no difference in the decrease in vessel diameter based on the application technique (suction vs suction plus grasping). A historical comparison with our former trials demonstrated that the OTSC decreased the vessel diameter significantly more than other traditional endoclips. Limitations Small sample size. Conclusions We could demonstrate the efficacy of the OTSC with increased hemodynamic efficiency compared with other endoscopic clip devices tested previously.
Background Various studies have demonstrated the usefulness of the over-the-scope-clip (OTSC) to treat perforations, anastomotic leaks, and fistulae. Endoscopic removal of the OTSC was previously ...described in a series of 3 patients by using the Nd:YAG laser. Objective To evaluate a new endoscopic technique to remove the OTSC. Design Prospective, single-arm, pilot study in an ex vivo porcine model. Interventions Perforations were created by using a surgical scalpel and a blunt trocar. Then they were endoscopically closed with the OTSC. Next, the OTSC was removed under endoscopic control by inserting a 0.035-inch straight hydrophilic tip guidewire into the oval hole on the side of the OTSC jaw. Afterward, the OTSC clip was removed by pulling on the wire. Results Fifteen perforations were closed: with the OTSC. In all of the cases, the endoscopic closure of the defects was feasible and effective. Successful visualization of the oval hole of the OTSC was possible in 12 cases (80%), and guidewire cannulation was possible in all of these 12 cases (100%). Advancement of the guidewire through the OTSC and then the lumen of the stomach was accomplished in 8 cases (53.3%). In all of the cases with successful cannulation of the orifice, removal of the OTSC was managed safely. The result was an overall success rate of 53.3% (8 of 15 cases). Limitations Ex vivo porcine model. Conclusions Guidewire removal is a new and feasible technique to remove the OTSC. Future studies should refine the technique to enhance visualization and cannulation of the oval hole of the OTSC.
Diagnostic and interventional endoscopy has undergone an enormous evolution and refinement in the past 2 decades. Consequently, the requirement of skill sets for endoscopists increased and a need for ...training and education have become clear. Since the mid-1990s, different training simulators have been developed. This article describes the status of endoscopy training in Europe and the current use of simulators in various European countries. Several working groups have developed and established various simulators and training platforms for nearly all diagnostic and interventional techniques. Therefore, the availability of different training simulators is not unexpected in most European countries.
