Movatterモバイル変換


[0]ホーム

URL:


Skip to main content

Advertisement

Springer Nature Link
Log in

How do we ensure that trainees learn to perform biliary sphincterotomy safely, appropriately, and effectively?

  • Published:
Current Gastroenterology Reports Aims and scope Submit manuscript

Abstract

Sphincterotomy is a high-risk procedure with considerable complications. Trainees should learn and understand the basics of endoscopic retrograde cholangiopancreatography and sphincterotomy to ensure good clinical outcomes. Teaching of sphincterotomy usually involves supervised hands-on clinical practice with patients. Proper positioning of the endoscope allows for correct orientation with the papilla, and performing the cut along the “ideal” biliary axis optimizes results and reduces complications. Learning and practicing sphincterotomy can be supplemented by simulator models. The Neo-Papilla model uses a modified chicken heart attached to the porcine ex vivo model and allows for cutting of actual tissue. The mechanical simulator allows trainees to practice cutting an artificial papilla marked with the “perfect” axis to understand the proper sphincterotomy technique. Understanding the indications and contraindications helps with appropriate application of sphincterotomy. Objective criteria should be available for assessing performance. Improved technique and avoiding a deviated cut may improve overall results and prevent complications.

This is a preview of subscription content,log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+
from ¥17,985 /Month
  • Starting from 10 chapters or articles per month
  • Access and download chapters and articles from more than 300k books and 2,500 journals
  • Cancel anytime
View plans

Buy Now

Price includes VAT (Japan)

Instant access to the full article PDF.

Similar content being viewed by others

Explore related subjects

Discover the latest articles, books and news in related subjects, suggested using machine learning.

References and Recommended Reading

  1. Leung J:Fundamentals of ERCP. InAdvanced Digestive Endoscopy: ERCP. Edited by Cotton PB, Leung JW. Oxford: Blackwell Science; 2005:17–80.

    Chapter  Google Scholar 

  2. Cotton PB, Lehman G, Vennes JA, et al.:Endoscopic sphincterotomy complications and their management: an attempt at consensus.Gastrointest Endosc 1991,37:383–393.

    Article PubMed CAS  Google Scholar 

  3. Freeman ML, DiSario JA, Nelson DB, et al.:Risk factors for post-ERCP pancreatitis: a prospective, multicenter study.Gastrointest Endosc 2001,96:417–423.

    Google Scholar 

  4. Freeman ML:Post-ERCP pancreatitis: patient and technique related risk factors.JOP 2002,3:169–176.

    PubMed  Google Scholar 

  5. Freeman ML, Nelson DB, Sherman S, et al.:Complications of endoscopic biliary sphincterotomy.N Engl J Med 1996,335:909–918.

    Article PubMed CAS  Google Scholar 

  6. Leung J, Leung F:Papillotomy Performance Scoring Scale: a pilot validation study focused on the cut axis.Aliment Pharmacol Ther 2006,24:308–312.

    Article  Google Scholar 

  7. Elta G, Barnett JL, Wille RT, et al.:Pure cut electrocautery current for sphincterotomy causes less post procedure pancreatitis than blended current.Gastrointest Endosc 1998,47:149–153.

    Article PubMed CAS  Google Scholar 

  8. Perini RF, Sadurski R, Cotton PB, et al.:Post sphincterotomy bleeding after the introduction of microprocessor-controlled electrocautery: does the new technology make the difference?Gastrointest Endosc 2005,61:53–57.

    Article PubMed  Google Scholar 

  9. Igarashi Y, Ukita T, Inoue H, et al.:Which modality can be standardized for endoscopic sphincterotomy in Japan.Digest Endosc 2002,14(Suppl):S10–S12.

    Article  Google Scholar 

  10. Sherman S, Yzer MF, Lehman GA:Wire-guided sphincterotomy.Am J Gastroenterol 1994,89:2125–2129.

    PubMed CAS  Google Scholar 

  11. Kim DK, Han JD, Choi JY, et al.:Do endoscopic sphincterotomy and periampullary diverticulum affect the results of endoscopic large balloon sphincteroplasty along with endoscopic phincterotomy in patients with large bile duct stones [abstract]?Gastrointest Endosc 2006,63:AB288.

    Article  Google Scholar 

  12. Cohen J:Training and credentialing in gastrointestinal endoscopy. InAdvanced Endoscopy E-Book: Endoscopy Practice and Safety. Edited by Cotton PB. Oxford: Blackwell Science; 2005:1–50.http://www.gastrohep.com.

    Google Scholar 

  13. Sedlack R, Petersen B, Binmoeller K, Kolars J:A direct comparison of ERCP teaching models.Gastrointest Endosc 2003,57:886–890.

    Article PubMed  Google Scholar 

  14. Nelson DB, Bosco JJ, Curtis WD, et al.:Technology status evaluation report: endoscopy simulators.Gastrointest Endosc 1999,51:790–792.

    Article  Google Scholar 

  15. Neumann M, Mayer G, Ell C, et al.:The Erlangen Endo-Trainer: lifelike simulation for diagnostic and interventional endoscopic retrograde cholangiography.Endoscopy 2000,32:906–910.

    Article PubMed CAS  Google Scholar 

  16. Sedlack RE, Petersen BT, Kolars JC:The impact of a hands-on ERCP workshop on clinical practice.Gastrointest Endosc 2005,61:67–71.

    Article PubMed  Google Scholar 

  17. Harewood GC, Baron TH:An assessment of the learning curve for precut biliary sphinctereotomy.Am J Gastroenterol 2002,97:1708–1712.

    Article PubMed CAS  Google Scholar 

  18. Matthes K, Cohen J:The Neo-Papilla: a new modification of porcine ex vivo simulators for ERCP training.Gastrointest Endosc 2006,64:570–576.

    Article PubMed  Google Scholar 

  19. Bar-Meir S:Simbionix simulator.Gastrointest Endosc Clin N Am 2006,16:471–478, vii.

    Article PubMed  Google Scholar 

  20. Leung J, Lee J, Wilson R, et al.:Development of a novel mechanical ERCP simulator.Gastrointest Endosc 2007,65:1056–1062.

    Article PubMed  Google Scholar 

  21. Williams EJ, Taylor S, Fairclough P, et al.:Are we meeting the standards set for endoscopy? Results of a large-scale prospective survey of endoscopic retrograde cholangio-pancreatograph practice.Gut 2007,56:821–829.

    Article PubMed  Google Scholar 

  22. Naylor G, Gatta L, Butler A, et al.:Setting up a quality assurance program in endoscopy.Endoscopy 2003,35:701–707.

    Article PubMed CAS  Google Scholar 

  23. Leung J, Leung F:Mechanical simulator for ERCP training [abstract].Gastrointest Endosc 2006,63:AB115.

    Article  Google Scholar 

  24. Cotton P:Quality lecture: towards excellence and accountability. InASGE Plenary Session: The Future of Endoscopy: What, Who and How. Program and Abstracts of Digestive Disease Week 2005. Chicago: American Society for Gastrointestinal Endoscopy; 2005.

    Google Scholar 

  25. Cotton PB:How many times have you done this procedure, doctor?Am J Gastroenterol 2002,7:522–523.

    Article  Google Scholar 

  26. Jowell PS, Baillie J, Branch MS, et al.:Quantitative assessment of procedural competence. A prospective study of training in endoscopic retrograde cholangiopancreatography.Ann Intern Med 1996,125:983–989.

    PubMed CAS  Google Scholar 

  27. Eisen GM, Baron TH, Dominitz JA, et al.:Methods of granting hospital privileges to perform gastrointestinal endoscopy.Gastrointest Endosc 2002,55:780–783.

    Article PubMed  Google Scholar 

  28. Verma D, Gostout CJ, Petersen BT, et al.:Establishing a true assessment of endoscopic competence in ERCP during training and beyond: a single-operator learning curve for deep biliary cannulation in patients with native papillary anatomy.Gastrointest Endosc 2007,65:394–400.

    Article PubMed  Google Scholar 

  29. Baillie J, Testoni PA:Are we meeting the standards set for ERCP?Gut 2007,56:744–746.

    Article PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Davis School of Medicine, University of California, 4150 V Street, Suite 3500 PSSB, Sacramento, CA, 95817, USA

    Joseph Leung

Authors
  1. Joseph Leung
  2. Erina Foster

Corresponding author

Correspondence toJoseph Leung.

Rights and permissions

About this article

Access this article

Subscribe and save

Springer+
from ¥17,985 /Month
  • Starting from 10 chapters or articles per month
  • Access and download chapters and articles from more than 300k books and 2,500 journals
  • Cancel anytime
View plans

Buy Now

Price includes VAT (Japan)

Instant access to the full article PDF.

Advertisement


[8]ページ先頭

©2009-2026 Movatter.jp