[Review] The Use of Simulation in Endoscopic Retrograde Cholangiopancreatography training: A Literature Review

Abstract

BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) is an advanced endoscopy procedure that has become the gold standard minimally invasive method of diagnosing and treating a vast variety of hepatopancreatobiliary diseases. It is associated with a significantly higher rate and wider range of adverse events compared with standard Upper GI endoscopy, with fewer of these procedures being performed in most centres and with procedure specific equipment and skills that most novice endoscopists will not be familiar with. These issues make training in ERCP challenging. AIMS: This literature review aims to look at the existing information available in the literature on the use of endoscopy simulators in ERCP training to see whether simulation training has a role in ERCP training, the main benefits and drawbacks of endoscopic simulation training, and how simulation training can be integrated into the learning process for achieving competence in ERCP. METHOD: Study searches were conducted in the MEDLINE, EMBASE, CENTRAL/Cochrane Library databases, Web of Science, Google Scholar, LILACS and FINDit. Studies assessing simulation training against traditional training or against other methods of simulation were identified for inclusion in this literature review. Results: Eight studies met the criteria for inclusion in this literature review with five of these being randomised control trials, where the primary outcome was biliary cannulation rates in simulation training against a control group. CONCLUSION: Simulation training has the potential to make trainees more knowledgeable about the basics of ERCP and help develop the technical skills required to perform ERCP competently, as shown by all four RCTs demonstrating that trainees in the simulation group had a statistically higher rate of achieving biliary cannulation against control groups. Endoscopic simulation training should be embedded in ERCP training programmes to act as an important part of the initial development of skills in a safe environment, where trainees can achieve a satisfactory level of proficiency before performing procedures on patients to limit the risk of adverse events and complications. Further trials are required to assess EMS and ECS against traditional methods of learning.