Efficacy of e-learning using video content in improving trainees' biliary cannulation skills and understanding (with video).

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E-learning with video content was created to improve trainees' biliary cannulation techniques; this study aimed to evaluate its educational effect prospectively. E-learning program was conducted using videos demonstrating biliary cannulation for 24 papillae, targeting trainees with 2-6 years of experience in endoscopic retrograde cholangiopancreatography. Ten consecutive cases of biliary cannulation for native papillae performed by trainees were prospectively assessed before and after the e-learning, respectively. The primary outcome was the difficult biliary cannulation rate; the secondary outcomes included a comprehension score assigned by the trainer for each biliary cannulation (maximum of 6 points), trainee failure rate, and adverse events incidence. Eleven trainees participated in the e-learning program. The overall and per-trainee analyses showed no significant differences in the difficult biliary cannulation rate, trainee failure rate, and adverse event incidence before and after e-learning. However, the overall analysis showed a significant increase in comprehension scores after e-learning (median 4vs. 5, p<0.01) and the per-trainee analysis revealed that the rate of comprehension score ≥5 increased significantly after e-learning (p=0.02). Comprehension score<5 (odds ratio: 4.31, p<0.01) and endoscopic retrograde cholangiopancreatography experience<3 years (odds ratio: 2.15, p=0.01) were independent risk factors for difficult biliary cannulation. Additionally, the difficult biliary cannulation incidence showed a negative correlation with the comprehension score (p<0.01). E-learning using video content did not result in a reduction in the difficult biliary cannulation rate. However, it significantly enhanced procedural understanding, indicating its potential to support future acquisition of biliary cannulation skills.