A simple ex vivo, biologic ERCP training model for sphincterotomy.

The key therapeutic intervention during endoscopic retrograde cholangiopancreatography (ERCP) is sphincterotomy, but lack of training and experience leads to a higher risk of complications [1,2]. Herein, we present a simple, reproducible, easyto-build, ex vivo, ERCP model for the training of sphincterotomy using standard sphincterotomes and a needle knife. The model is based on incorporating one or more chicken hearts into a pig stomach (●" Fig.1,●" Fig.2,●" Fig.3,●" Video 1). The native pig papilla has some limitations for sphincterotomy training, mainly because of its awkward location in the bulb compared with in the second duodenum in humans. To solve this issue, we previously created a model in which the pig stomach was “duodenalized” to resemble the duodenal sweep in humans [3]. The duodenalization overcame the common position problems when performing ERCP in intact pig stomachs, which are large and J-shaped. In a further development of Fig.1 Chicken hearts serve as ideal models for papillae. Their shape and anatomy resemble true ampullae. a The ventricle and aorta are perfectly suited to create a “bile duct” channel. b The chicken hearts can be cut in half to create smaller “papillae.” c The ventricle can be punctured to create a papillary orifice. d An implanted papilla. e Stent inserted into implanted papilla.