The Neo-Papilla: a new modification of porcine ex vivo simulators for ERCP training (with videos)

BackgroundComputer simulators, live pigs, and ex vivo porcine simulators are used for training in ERCP. The location of the porcine biliary orifice in the proximal duodenum is dissimilar to human anatomy, making the endoscopy experience less realistic. In addition, in native porcine anatomy, the pancreatic duct enters the duodenum distal to the biliary orifice, limiting the teaching of pancreatic techniques and selective duct cannulation.ObjectiveTo overcome these limitations, we aimed to construct a Neo-Papilla that could be incorporated into an ex vivo model.DesignWe attached chicken heart tissue to the porcine duodenum, with integrated porcine arteries that resembled an artificial common bile duct and a pancreatic duct.SettingThe simulator was presented and evaluated at 2 major GI endoscopy conferences.Main Outcome MeasurementsThe feasibility and the realism of this prototype was tested by 9 recognized ERCP experts who rated this model in comparison to other teaching models for ERCP by recollection of prior experience.ResultsThe Neo-Papilla was more prominent and more distally located than the native porcine papilla. The experts rated this modification superior to existing models in its usefulness as an educational tool.LimitationsPilot study.ConclusionsWe demonstrated the technical feasibility of a real-tissue Neo-Papilla modification of porcine ex vivo simulators, more closely approximating the natural anatomy. This new model should facilitate ERCP training. Formal validation studies are warranted.