Proposed Experimental Model for Qualification of Endoscopic Practices

Background: It is estimated that about 80 million Americans are affected by digestive diseases, and about 30 million endoscopic procedures are performed annually in the US. In Brazil, it was estimated that the national average of endoscopies number was 600 tests / 100,000 inhabitants per year. Despite the common nature of the procedures, there is no standard methodology for the training of endoscopists or when a trainee met important technical competence. In addition, there is no tool that determines the qualification of front trainees to familiarize themselves with the endoscope and endoscopic equipment for clinicalprocedures. Aim: to validate an experimental model through the use of the upper gastrointestinal tract of swine (pig), shaping it with use of linear staplers, manual anastomoses and mannequins in order to train and improve the technical endoscopic. Methods:advancement and improvement of endoscopic practices and procedures by new experimental model will help the emergence of a sector of this area facing the resolution of these complications of bariatric surgery. Results: Endoscopic practices, using the experimental model of the gastrointestinal tract of pigs, were significant to provide better training and capacity building to endoscopy professionals, as demonstrated in the videos. Conclusion: the endoscopies professionals were able to safely simulate the endoscopic procedure in an experimental model, thus ensuring the new technical training. Proposed Experimental Model for Qualification of Endoscopic Practices Publication History: Received: July 15, 2015 Accepted: September 05, 2015 Published: September 07, 2015


Short Communication
It is estimated that about 80 million Americans are affected by digestive diseases, and about 30 million endoscopic procedures are performed annually in the US [1,2].In Brazil, it was estimated that the national average of endoscopies number was 600 tests / 100,000 inhabitants per year [3][4][5][6].This number compared with the data collected from public health services in England, the Netherlands and Ireland, respectively 1000, 1200 and 1400 by 100,000 / inhabitants / year [6,8].Thus, it is observed that in Brazil the average number of examinations per year is lower compared to other countries, being necessary to invest in training techniques to facilitate the inclusion of new professionals as well as improving the skills of professionals [6].Despite the common nature of the procedures, there is no standard methodology for the training of endoscopists or when a trainee met important technical competence.In addition, there is no tool that determines the qualification of front trainees to familiarize themselves with the endoscope and endoscopic equipment for clinical procedures [3,4].
As demand requirement, there is an increasing number of patients undergoing bariatric surgery that is increasingly demanding that professionals know the therapeutic and endoscopic aspects of the main gastroenterological repercussions of bariatric operations [1,2,3].As a consequence, some of the complications may arise after the completion of this surgery as the emergence of strictures, fistulas, ring migration and regained weight, conditions which until recently were resolved through a new surgical procedures [7,8].

International Journal of Gastroenterology Disorders & Therapy
Luiz Gustavo de Quadros Thus, advancement and improvement of endoscopic practices and procedures help the emergence of a sector of this area facing the resolution of these complications of bariatric surgery.Thus, stenoses of the gastrointestinal anastomoses are corrected through the use of balloon dilator with symptomatic improvement of patients after the [1,2] procedure.
The cases of regained weight, related to dilation of gastrojejunal anastomosis, is a therapeutic option by using argon plasma, causing a fibrotic scar and consequent reduction of the diameter of anastomosis [1,2].Since migration of the ring in gastric bypass and stenosis , and even fistulae they can be solved by positioning the prosthesis by means of endoscopy [1,3].
Despite the emergence of these new less invasive techniques that require less treatment time, are less expensive and present less risk to the surgical procedure, there are few experimental models that provide the training of professionals in the endoscopists optimized the procedures [2,4,5].Thus, it aimed to validate an experimental model through the use of the upper gastrointestinal tract of swine (pig), as figure 1, shaping it with use of linear staplers, manual anastomoses and mannequins in order to train and improve the technical endoscopic.

Methods
Advancement and improvement of methods and new experimental model of endoscopic procedures will contribute to improving techniques to resolve complications of bariatric surgery through the experimental model which used the upper gastrointestinal tract of pigs, as Figure 1, shaping it using linear staplers, manual anastomoses and mannequins.

Results
Endoscopic practices, using the experimental model of the gastrointestinal tract of pigs, were significant to provide better training and capacity building to endoscopy professionals, as demonstrated in the three videos that are attached.

Conclusion
The endoscopies professionals were able to safely simulate the endoscopic procedure in an experimental model, thus ensuring the new technical training.

Important Statements
The pieces were placed in a modified mannequin model SOBED (Brazilian Society of Digestive Endoscopy) developed by Dr. Ricardo Anuar Dib and Dr. Marco AurélioD'Assunção .In addition, the photos and the training were made in amits-Barretos/SP-Brazil.

Figure 1 :
Figure 1: Experimental model of the gastrointestinal tract of pig and its modeling for endoscopic training.