Dhir, Vinay; Itoi, Takao; Fockens, Paul; Perez-Miranda, Manuel; Khashab, Mouen A; Seo, Dong Wan; Yang, Ai Ming; Lawrence, Khek Yu; Maydeo, Amit
Gastrointestinal endoscopy
2015Feb ; 81 ( 2 ) :440-6.
PMID : 25475900
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Dhir, Vinay - Baldota Institute of Digestive Sciences, Mumbai, India.
Itoi, Takao - Tokyo Medical University, Tokyo, Japan.
Fockens, Paul - Academic medical Centre, Amsterdam, Netherlands.
Perez-Miranda, Manuel - Valladolid University Medical School, Valladolid, Spain.
Khashab, Mouen A - Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Seo, Dong Wan - Asan Medical Center, Seoul, South Korea.
Yang, Ai Ming - Peking University Medical Center Hospital, Beijing, China.
Lawrence, Khek Yu - National University Health System, Singapore.
Maydeo, Amit - Baldota Institute of Digestive Sciences, Mumbai, India.
ABSTRACT
BACKGROUND: EUS-guided biliary drainage (EUS-BD) has emerged as an alternative rescue method in patients with failed ERCP. Opportunities for teaching and training are limited because of a low case volume at most centers. OBJECTIVE: To evaluate a stereolithography/3-dimensional (3D) printing bile duct prototype for teaching and training in EUS-BD. DESIGN: Prospective observational feasibility study. SETTING: Tertiary referral center. SUBJECTS: Twenty endosonographers attending an interventional EUS workshop. INTERVENTION: A prototype of a dilated biliary system was prepared by computer-aided design and 3D printing. The study participants performed guidewire manipulation and EUS-BD procedures (antegrade procedure and/or choledochoduodenostomy) on the prototype. Participants were scored with the device on a scale of 1 to 5 via a questionnaire. Participants' success rate for various steps of the EUS-BD procedure was noted. MAIN OUTCOME MEASUREMENTS: Subjective and objective evaluation of the prototype regarding its overall applicability, quality of radiographic and EUS images, and 4 steps of EUS-BD procedure (needle puncture, guidewire manipulation, tract dilation, stent placement).
RESULTS: Fifteen participants returned the questionnaire, and 10 completed all 4 steps of EUS-BD. The median score for overall utility was 4, whereas that for EUS and US views was 5. Participants with experience in performing more than 20 EUS-BD procedures scored the prototype significantly lower for stent placement (P?= .013) and equivalent for needle puncture, tract dilation, and wire manipulation. The success rate of various steps was 100% for needle puncture and tract dilation, 82.35% for wire manipulation, and 80% for stent placement. The mean overall procedure time was 18 minutes. LIMITATIONS: Small number of participants. CONCLUSION: The 3D printing bile duct prototype appears suitable for teaching of and training in the various steps of EUS-BD. Further studies are required to elucidate its role. CI - Copyright ??2015 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
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MESH
Bile Ducts, Intrahepatic, Common Bile Duct, *Drainage/instrumentation/methods, *Endosonography/methods, Equipment Design, Feasibility Studies, Gastroenterology/*education, Humans, *Models, Anatomic, *Models, Educational, Polycarboxylate Cement, *Printing, Three-Dimensional, Prospective Studies, Stents, *Ultrasonography, Interventional/methods, United States
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