Digestive Diseases and Sciences

, Volume 61, Issue 3, pp 722–730 | Cite as

Can a Computerized Simulator Assess Skill Level and Improvement in Performance of ERCP?

  • Ara B. Sahakian
  • Loren Laine
  • Priya A. Jamidar
  • Uzma D. Siddiqui
  • Andrew Duffy
  • Maria M. Ciarleglio
  • Yanhong Deng
  • Anil Nagar
  • Harry R. Aslanian
Original Article



Endoscopic retrograde cholangiography (ERCP) is a challenging procedure with considerable risk. Computerized simulators are valuable in training for flexible endoscopy, but little data exist for their use in ERCP training.


To determine a simulator’s ability to assess the level of ERCP skill and its responsiveness over time to increasing trainee experience.

Materials and Methods

In this prospective parallel-arm cohort study, six novice gastroenterology fellows and four gastroenterology faculty with expertise in ERCP completed four simulated baseline cases and the same four cases at a later date. This study took place at a surgical skills center at an academic tertiary referral center. The primary outcome was the total time to complete the ERCP procedure.


For the baseline session, experts had a shorter total procedure time than novices (444.0 vs. 616.9 s; least squares mean; p = 0.026). There was no significant difference between experts and novices in the difference of total procedure time between session 1 and session 2 (−200.3 vs. −164.4; least squares mean; p = 0.402).


The simulator was able to differentiate experts from novices for the primary outcome of total procedure time. The simulator was not responsive to an increase in trainee experience over time.


ERCP training Endoscopy quality measures ERCP simulator ERCP Endoscopy simulators 



Endoscopic retrograde cholangiopancreatography




Standard deviation


Standard error


Author contributions

Sahakian involved in study design, data collection, and data analysis and drafted the manuscript. Laine and Aslanian involved in study design and data analysis and revised the manuscript. Jamidar, Siddiqui, and Nagar involved in study design and revised the manuscript. Duffy revised the manuscript. Ciarleglio and Deng involved in data analysis and revised the manuscript.

Compliance with ethical standards

Conflict of interest



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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Ara B. Sahakian
    • 1
  • Loren Laine
    • 2
    • 3
  • Priya A. Jamidar
    • 2
  • Uzma D. Siddiqui
    • 4
  • Andrew Duffy
    • 5
  • Maria M. Ciarleglio
    • 6
  • Yanhong Deng
    • 7
  • Anil Nagar
    • 2
    • 3
  • Harry R. Aslanian
    • 2
  1. 1.Division of Gastrointestinal and Liver DiseasesUniversity of Southern California School of MedicineLos AngelesUSA
  2. 2.Section of Digestive DiseasesYale University School of MedicineNew HavenUSA
  3. 3.Section of Digestive DiseasesV.A. Connecticut Healthcare SystemWest HavenUSA
  4. 4.Section of GastroenterologyUniversity of ChicagoChicagoUSA
  5. 5.Department of SurgeryYale University School of MedicineNew HavenUSA
  6. 6.Department of BiostatisticsYale School of Public HealthNew HavenUSA
  7. 7.Yale Center for Analytical SciencesYale School of Public HealthNew HavenUSA

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