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. 2022 May-Jun;11(3):201-207.
doi: 10.4103/EUS-D-21-00109.

Evaluation of the ex-vivo porcine simulator on EUS-guided cystogastrostomy using lumen-apposing metal stent training

Mostafa Ibrahim  1 , Noran Roshdy  2 , Amerah Taleb  3 , Abdulrahman Alfadda  4 , Abed Al-Lehibi  5 , Ahmed Altonbary  6 , Ahmed Galal  7 , Amr El-Fouly  8 , Anna Kozlowska  9 , Christopher Khor  10 , Hiroyuki Isayama  11 , Hussein Okasha  12 , Marc Barthet  13 , Marc Giovannini  14 , Nonthalee Pausawasdi  15 , Pierre Eisendrath  16 , Pradermchai Kongkam  17 , Thawee Ratanachu-Ek  18 , Yousuke Nakai  19
Affiliations

Evaluation of the ex-vivo porcine simulator on EUS-guided cystogastrostomy using lumen-apposing metal stent training

Mostafa Ibrahim et al. Endosc Ultrasound. 2022 May-Jun.

Abstract

Bckground and objectives: EUS-guided cystogastrostomy is a well-established advanced endoscopic technique with a steep-learning curve which necessitates an ex-vivo simulator that would allow for adequate training. The aim of this study is to evaluate the feasibility of the model in allowing training for EUS-guided cystogastrostomy using lumen-apposing metal stent (LAMS).

Subjects and methods: The model was created by ROEYA Training Center, Egypt, using native porcine tissue to create fluid collections simulating both cystic and solid lesions. It was designed and tested in advance while the hydrogel was added on-site. The simulator was evaluated prospectively in five training sessions involving 17 international experts. The task was to successfully deploy the LAMS to drain the created cyst. After using the simulator, the experts were asked to fill a questionnaire to assess their experience. The primary endpoint was overall satisfaction with the model as a training tool.

Results: All of the experts were satisfied with the model as a tool to train endoscopists for the technique. 76.5% (n = 11) of the experts thought the model to be moderately realistic. Proper visualization was reported by 94.1% of the experts. All experts believed the lesions to be either slightly like or very similar to real lesions. The model was graded "easy" in difficulty by 11 of the experts.

Conclusions: In all parameters assessed, the experts thought the model to be a useful tool for future training. This preliminary study suggests that the aforementioned simulator can be used to train endoscopists on using LAMS in a risk-free environment.

Keywords: EUS-guided drainage; cystogastrostomy; training model.

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Conflict of interest statement

None

Figures

Figure 1
Figure 1
EUS view of the created cyst
Figure 2
Figure 2
Black and white image for the released stent (representative of X-RAY view)
Figure 3
Figure 3
EUS-guided puncture of the created lesion
Figure 4
Figure 4
Endoscopic image of the cyst after puncture achieved with full deployment of the stent
Figure 5
Figure 5
Results of expert questionnaire when asked about their impression of realism
Figure 6
Figure 6
Results of expert questionnaire when asked about visualization of the target lesion
Figure 7
Figure 7
Results of expert questionnaire when asked about anatomical accuracy
Figure 8
Figure 8
Results of expert questionnaire when asked about overall difficulty of the model
Figure 9
Figure 9
Results of expert questionnaire when asked if training on model helped their clinical practice
Figure 10
Figure 10
Results of expert questionnaire when asked about procedure time after training
Figure 11
Figure 11
Results of expert questionnaire when asked about postprocedure side effects after training
See this image and copyright information in PMC

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