Comparative evaluation of two porcine ex vivo models for training in endoscopic ultrasound-guided drainage of pancreatic fluid collections


Introduction: EUS-guided cystoenterostomy (EUCE), a technique used for the drainage of pancreatic pseudocysts and peri-enteric collections, requires specific skills for which dedicated models are needed. Based on a compact EASIE model (Erlangen Active Simulator for Interventional Endoscopy), we developed two ex vivo porcine models of retrogastric cysts and evaluated learning performance within the frame of a structured training program.

Material and methods: The first model was made of porcine colon (i. e. « natural cyst »), the second one with an ostomy bag (i. e. « artificial cyst »). All procedures were achieved with an EUS scope under fluoroscopy. Both models were evaluated prospectively over a 2-day session involving 14 students and five experts. The primary end point was overall satisfaction with each model.

Results: The « natural cyst » and « artificial cyst » were prepared within 10 and 16.5 minutes ( P = 0.78), respectively. Model grading showed a non-significant trend for overall satisfaction in favor of the artificial model ( P = 0.06). As secondary end points, difference was not significant for impression of realism ( P = 0.75) whereas the « artificial cyst » was graded significantly better by experts and students in terms of ability to teach procedural steps ( P = 0.01) and ease of puncture ( P = 0.03). Moreover, experts considered the ability to improve students’ proficiency to be superior with the « artificial cyst » ( P = 0.008).

Conclusion: Both « artificial » and « natural cysts » are efficient for EUCE training in terms of overall satisfaction. However, the « artificial cyst » model appears to make the procedure easier with a higher ability to teach procedural steps and improve the students’ proficiency. Larger applications of this model are needed to validate as a standard of training.

Conflict of interest statement

Competing interests None