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. 2023 Apr 30;12(9):3230.
doi: 10.3390/jcm12093230.

Evaluation of a New Animal Tissue-Free Bleeding Model for Training of Endoscopic Hemostasis

Dörte Wichmann  1   2   3 , Sarah Grether  1   4 , Jana Fundel  1   5 , Ulrich Schweizer  1   2   3 , Edris Wedi  6 , Benjamin Walter  7 , Alfred Königsrainer  3 , Benedikt Duckworth-Mothes  1
Affiliations

Evaluation of a New Animal Tissue-Free Bleeding Model for Training of Endoscopic Hemostasis

Dörte Wichmann et al. J Clin Med. .

Abstract

Background: For endoscopists, knowledge of the available hemotherapeutic devices and materials as well as competence in using them is a life-saving expertise in the treatment of patients with acute gastrointestinal bleeding. These competences can be acquired in training on live animals, animal organs, or simulators. We present an animal tissue-free training model of the upper gastrointestinal tract for bleeding therapy.

Methods: An artificial, animal tissue-free mucosa and submucosa with the opportunity of injection and clipping therapy were created first. Patches with this artificial mucosa and submucosa were placed into silicone and latex organs with human-like anatomy. Esophageal bleeding situations were imitated as variceal bleeding and bleeding of a reflux esophagitis in latex organs. Finally, a modular training model with human anatomy and replaceable bleeding sources was created. Evaluation of the novel model for gastroscopic training was performed in a multicentric setting with endoscopic beginners and experts.

Results: Evaluation was carried out by 38 physicians with different levels of education in endoscopy. Evaluation of the model was made with grades from one (excellent) to six (bad): suitability for endoscopic training was 1.4, relevance of the endoscopic training was 1.6, and grading for haptic and optic impression of the model was 1.7.

Conclusions: The creation of a gastroscopic model for the training of hemostatic techniques without animal tissues was possible and multiple endoscopic bleeding skills could be trained in it. Evaluation showed good results for this new training option, which could be used in every endoscopic unit or other places without hygienic doubts.

Keywords: clipping for hemostasis; hemostasis; training endoscopy; training in endoscopic hemostasis; variceal banding.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The artificial mucosa patch.
Figure 2
Figure 2
Structure of the bleeding patch (a) 3D-printed sealing cap, (b) submucosal layer placed into the sealing cap, (c) artificial vessel over the submucosa, an impermeable layer separates the vessel from the submucosal layer, (d) final changeable bleeding patch with mucosal layer as the top layer, the blue arrow marks the location of the bleeding.
Figure 3
Figure 3
Endoluminal findings by simulating bleedings (a) active bleeding in gastric position, the red arrow marks the bleeding; (b) successful hemostasis by Through-The-Scope-Clips; (c) bleeding patch in duodenal position with successful treatment with an Over-The-Scope-Clip.
Figure 4
Figure 4
Endoscopic view on the artificial bleeding varices ((a), with uncolored water), during banding (b) and after successful variceal banding therapy (c).
Figure 5
Figure 5
Endoscopic view (a) on a bleeding reflux esophagitis and (b) after application of a hemostatic powder.
Figure 6
Figure 6
Flowchart of the evaluation procedure.
Figure 7
Figure 7
Training model (a) final construction with covered model, in the background the mechanical pump with the artificial blood is visible, (b) uncovered model, visible are the connections for the bleeding patches.
See this image and copyright information in PMC

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