Prior Experience and Use of Short Wire Technology Predicts Faster ERCP Procedure Time

Abstract

Purpose: Therapeutic ERCP requires advanced training beyond regular endoscopy. ERCP utilizes side-viewing scopes and different accessories, in addition to fluoroscopy. Close coordination is required between endoscopist and assistant in manipulating accessories. Traditional teaching involves use of conventional long accessories. The short wire Fusion system minimizes exchanges, allows better control by the endoscopist and less reliance on the assistant, thus shortening the ERCP procedure. Aim: Using a mechanical simulator, we determine 1. if use of short accessories will shorten procedure time compared to long accessories, and 2. determine the possible correlation between procedure time and actual ERCP skill (total experience). Methods: 13 advanced GI fellows from the Western United States participated in a hands-on practice ERCP course. An anonymous survey documents the pre-practice endoscopy experience, and post-practice evaluation of simulator practice in ERCP training. ERCP was performed using a mechanical simulator and an artificial bile duct with a built-in stricture. A pin-hole camera is used in place of fluoroscopy to monitor events within the bile duct. Time taken (minutes) to negotiate the stricture with a guide wire, perform balloon dilation and brushing cytology, and insertion of a plastic biliary stent using the conventional method or Fusion system were determined. The total procedure time (TT) and fluoroscopy time (FT) were taken. Each fellow was paired with an experienced assistant and each set of tasks was repeated two times. Five experienced biliary attendings also performed the same tasks. T-tests were used for statistical analysis. Results: The mean TT and FT taken by fellows (n = 13) was 15.1 min and 4.31 min for long accessories and 12.6 min and 4.88 min for the Fusion system respectively. The difference for TT between long and short accessories (p < 0.05) was significant, but not FT (p = 0.14). The mean TT for attendings using long accessories was 7.87 min and 6.43 minutes for the Fusion system (p = 0.02). The differences in both time taken for long and short accessories between fellows and attendings were significant (p < 0.005 for both). Conclusions: The mechanical simulator allows comparison of objective data for ERCP practice with different accessories. The procedure time is inversely related to the total ERCP experience. Short wire and accessories may shorten procedure time compared to long accessories.