Evaluation of the ex-vivo porcine simulator on EUS-guided cystogastrostomy using lumen-apposing metal stent training Ibrahim M, Roshdy N, Taleb A, Alfadda A, Al-Lehibi A, Altonbary A, Galal A, El-Fouly A, Kozlowska A, Khor C, Isayama H, Okasha H, Barthet M, Giovannini M, Pausawasdi N, Eisendrath P, Kongkam P, Ratanachu-ek T, Nakai Y,

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Evaluation of the ex-vivo porcine simulator on EUS-guided cystogastrostomy using lumen-apposing metal stent training Mostafa Ibrahim¹, Noran Roshdy², Amerah Taleb³, Abdulrahman Alfadda⁴, Abed Al-Lehibi⁵, Ahmed Altonbary⁶, Ahmed Galal⁷, Amr El-Fouly⁸, Anna Kozlowska⁹, Christopher Khor¹⁰, Hiroyuki Isayama¹¹, Hussein Okasha¹², Marc Barthet¹³, Marc Giovannini¹⁴, Nonthalee Pausawasdi¹⁵, Pierre Eisendrath¹⁶, Pradermchai Kongkam¹⁷, Thawee Ratanachu-ek¹⁸, Yousuke Nakai¹⁹ ¹ Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, Université Libre de Bruxelles, Brussels, Belgium; Department of Gastroenterology and Hepatology, Theodor Bilharz Research Institute, Cairo, Egypt ² ROEYA Gastroenterology, Hepatology and Endoscopy Center, Cairo, Egypt ³ New Giza University, Cairo, Egypt ⁴ Department of Gastroenterology and Hepatology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia ⁵ Department of Gastroenterology and Hepatology, King Fahad Medical City, Riyadh, Saudi Arabia ⁶ Department of Gastroenterology and Hepatology, Mansoura University, Egypt ⁷ Department of Gastroenterology, Alexandria Hospital, Egypt ⁸ Endemic Medicine Department, Helwan University, Egypt ⁹ Department of Endoscopy, Hospital of Ministry of Internal Affairs, Szczecin, Poland ¹⁰ Department of Gastroenterology & Hepatology, Singapore General Hospital, Singapore ¹¹ Department of Gastroenterology, Juntendo University, Tokyo, Japan ¹² Internal Medicine Department, Kasr Al-Ainy School of Medicine, Cairo University, Egypt ¹³ Department of Gastroenterology & Hepatology, Hospital Nord, Marseille, France ¹⁴ Department of Gastroenterology & Hepatology, Paoli Calmettes Institute, Marseille, France ¹⁵ Division of Gastroenterology, Department of Medicine, Siriraj Hospital, Bangkok, Thailand ¹⁶ Department of Hepato-Gastroenterology, Saint-Pierre Hospital, Brussels, Belgium ¹⁷ Division of Gastroenterology, Department of Medicine, Chulalongkom University, Bangkok, Thailand ¹⁸ Rajavithi Digestive Endoscopy Center, Bangkok, Thailand ¹⁹ Department of Endoscopy and Endoscopic Surgery, University of Tokyo, Tokyo, Japan Correspondence Address: Mostafa Ibrahim, Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, Université Libre de Bruxelles, Brussels Source of Support: None, Conflict of Interest: None DOI: 10.4103/EUS-D-21-00109

Bckground and Objectives: EUS-guided cystogastrostomy is a well-established advanced endoscopic technique with a steep-learning curve which necessitates an ex-vivo simulator that would allow for adequate training. The aim of this study is to evaluate the feasibility of the model in allowing training for EUS-guided cystogastrostomy using lumen-apposing metal stent (LAMS). Subjects and Methods: The model was created by ROEYA Training Center, Egypt, using native porcine tissue to create fluid collections simulating both cystic and solid lesions. It was designed and tested in advance while the hydrogel was added on-site. The simulator was evaluated prospectively in five training sessions involving 17 international experts. The task was to successfully deploy the LAMS to drain the created cyst. After using the simulator, the experts were asked to fill a questionnaire to assess their experience. The primary endpoint was overall satisfaction with the model as a training tool. Results: All of the experts were satisfied with the model as a tool to train endoscopists for the technique. 76.5% (n = 11) of the experts thought the model to be moderately realistic. Proper visualization was reported by 94.1% of the experts. All experts believed the lesions to be either slightly like or very similar to real lesions. The model was graded “easy” in difficulty by 11 of the experts. Conclusions: In all parameters assessed, the experts thought the model to be a useful tool for future training. This preliminary study suggests that the aforementioned simulator can be used to train endoscopists on using LAMS in a risk-free environment.

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    -  Ibrahim M
    -  Roshdy N
    -  Taleb A
    -  Alfadda A
    -  Al-Lehibi A
    -  Altonbary A
    -  Galal A
    -  El-Fouly A
    -  Kozlowska A
    -  Khor C
    -  Isayama H
    -  Okasha H
    -  Barthet M
    -  Giovannini M
    -  Pausawasdi N
    -  Eisendrath P
    -  Kongkam P
    -  Ratanachu-ek T
    -  Nakai Y

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