Hands On Training Course In Endoscopy

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Brief

Endoscopic Virtual Reality Simulator both for Upper & Lower gastrointestinal training. This new generation of interventional simulation, uses advanced graphics that depict anatomical structures with stunning realism. The haptic technology that accurately replicates the use of a scope during the procedure, brings this learning exercise so close to an actual OR experience.  All patient cases are developed using real patient data and physiological models. An extensive  library of pathologies can be utilized for the training curriculum. The simulator tracks each and every action during the procedure, and gives detailed results to the trainer to give an analytical feedback to the learner during the post debrief session, metrics to track time, proficiency, dexterity and complications on each task and compare a learner’s results with the instructor’s established acceptable results.

Eligible Participants

 

  • Resident in general surgery, medicine and pediatrics who want to pursue career in Gastroenterology & Endoscopy.
  • Young general surgeons who want to upgrade themselves in endoscopy.

 

Programme Outline

Simulation- Introduction, why & how based training.

 

  • How to work on simulators (Demonstration).
  • Upper GI Scopy 1 (Indication, Patient Preparation, Technique)
  • Upper GI Scopy 2 (In various diseases of upper GI tract, UGI scopy in GI bleeding)
  • Colonoscopy (Indication, Patient Preparation, Technique)
  • Colonoscopic Procedures (Biopsy, Polypectomy)
  • ERCP (Indication, Patient Preparation, Technique)
  • Prevention and management of Endoscopic Complications.
  • Debriefing
  • Feedback and hands on training module selection. Hands On Training.

 

 

Hands on training offer candidate complete experience of doing endoscopy as in real life. It will help them to understand the difference maneuvers, movements and navigation techniques. At the end you can see the result of your work. There are six module candidate require to spend minimum 1 week time on simulator.

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Packages
Programs Name of procedure No. of cases
Program-1 Diagnostic UGI 6
Program-2 Endoscopy in GI bleeding 6
Program-3 Endoscopic Retrograde Cholangiopancreatography (ERCP) 6
Program-4 Basic Sigmoidoscopy & Colonoscopy 12
Program-5 Colonoscopic Bx & Polypecton 12
Program-6 Case Capsuler 10

1. Diagnostic Upper GI Scopy – 6 Case Scenarios

It Covers technical skills needed for performing diagnostic upper gastrointestinal procedures in a simulator environment for different clinical conditions.

Training Objectives:

  • Navigation scope through upper GI tract.
  • Negotiating cricoid, pylorus & Duodenum.
  • To acquire tips & techniques for overcoming common challenges.
  • Doing pectroflexion to inspect funder.

Case Scenarios- 6 cases

  • Patient presented with epigastric pain associated with vomiting.
  • Patient presented with Dysphagia and heartburn.
  • Patient presented with H/O crohn’s disease with right upper abdominal pain.
  • K/C/O recurrent pancreatitis with dilated PD with operation case of colectomy for polyposis coli.
  • Patient presented with H/O chronic pancreatitis with epigastric pain with deranged LFT’s
  • Patient presented with dysphagia.

2. Endoscopy in GI bleeding 6  Case Scenarios.

Training Objectives

  • To learn scope navigation and negotiation.
  • To learn basic management of UGI bleed.
  • To learn difference between.

Case Scenarios- 6 cases

  • 30 year Male, H/O gastric ulcer presented with epigastric pain on examination moderate tenderness in epigastric region without jaundice, guarding or rigidity.
  •  Patient presented with two episodes of coffee ground vomiting with history of epigastric pain for part one week.
  • Presented with melaena since 24 hrs H/O nausea, epigastric pain & dizziness no H/O peptic ulcer 10 year ago treated with PPI
  • Presented with two episodes of hematemesis H/O dyspepsia H/O treatment for H-pylori eradication H/O repeated black stools.
  • Presented with brief syncopal after passing dark burgundy stool at home H/O two fresh episodes of hematemesis. Active bleeding through NG tube.
  • The patient complaining of increasing epigastric discomport over the last month.

3. Introduction to Endoscopic Retrograde Cholangio-Pancreatography (ERCP) : 6 Case Scenarios

Training objectives:

The Introduction to Endoscopic Retrograde Cholangiopancreatography (ERCP) module covers the technical skills needed for selective cannulation of the biliary and pancreatic ducts in a simulated environment. It provides valuable practice in navigating the duo denoscope to the duodenum, orienting the side-viewing endoscope to the major and minor papillae, cannulating the papillae, injecting contrast under fluoroscopy, and interpreting fluoroscopic images.

Upon completion of this module, the user will be able to:

  • Validate techniques for orienting the duodenoscope and selective cannulation of the respective ducts in a simulated environment.
  • Appreciate why ERCP requires a side-viewing scope with an elevator.
  • Identify pathology and understand why contrast and fluoroscopy are needed to visualize ductal variations.
  • Discuss the indications, contraindications and complications of ERCP.
  • Describe the common anatomic and pathologic variations of the biliary and pancreatic ducts.
  • Understand the safe use of fluoroscopy in ERCP and some of its potential complications.
  • Deliberate tips and techniques for overcoming common challenges specific to ERCP.

 Case scenarios – 6 Cases

  • Patient who is 18 days post-partum. She presents with right upper quadrant pain and emesis.
  • Patient who presents with right upper quadrant pain for 4 days..
  • Patient with a history of Crohn’s disease who presents with right upper quadrant pain and emesis.
  • Patient with a documented history of 3 attacks of acute pancreatitis.
  • Patient with a history of chronic pancreatitis. He presents with recurring epigastric pain that will not subside.
  • Patient who presents with recurrent pancreatitis. ALT, AST, glucose, LDH, and WBC were all elevated with each episode.

4. Basic Sigmoidoscopy & Colonoscopy 12 Case Scenarios

 Training Objectives :

The Introduction to Flexible Sigmoidoscopy module focuses on operating the flexible sigmoidoscope, navigating it through the colon, performing a visual examination of the colonic mucosa and identifying a variety of colorectal lesions. Cases are presented that require a complete flexible sigmoidoscopy examination.

Upon completion of this module, the user will be able to:

  • Describe the anatomy of the colon pertinent to sigmoidoscopy.
  • Demonstrate the operation of the flexible sigmoidoscope.
  • Perform a simulated flexible sigmoidoscopy examination. 
  • Describe common colorectal lesions encountered during flexible sigmoidoscopy. 
  • Discuss tips and techniques for overcoming common problems.

 Case  Senarios – 12Cases 

  • Patient presents for colorectal cancer screening.
  • Patient presents for colorectal cancer screening. She is asymptomatic. Her family history is significant for father having polyps.
  • Patient with known diverticular disease. He undergoes screening every 5 years. No polyps have been detected on previous exams.
  • Patient presents with intermittent painless rectal bleeding. Her family history is negative for colorectal cancer.
  • Patient presents with a chief complaint of fatigue. He has a recent history of small caliber stools.
  • Patient presents for her first colorectal cancer screening exam. Past medical history is significant for hysterectomy 15 years ago. Her family history is significant for polyps detected in 52 y.o. brother.
  • History of intermittent diarrhea associated with crampy lower abdominal pain. The pain is sometimes relieved by defecation.
  • Increased urgency to defecate, mild-to-moderate lower abdominal cramps, and 3-5 loose stools per day intermittently mixed with blood.
  • Patient is 12 days status post cholecystectomy due to acute cholecystitis. Completed a 7-day course of antibiotics. Patient states that for the last 2 days, he has had increased bowel movements, nearly 10 stools per day, and lower left abdominal pain.
  • Patient with 6 days of intermittent bloodless diarrhea and colicky abdominal pain in the RLQ. She recalls having a bout of diarrhea for 3 days roughly 2 weeks ago.
  • Surveillance colonoscopy. Medical history is relevant for diverticula on previous colonoscopy.
  • Patient has Intermittent black stools. Patient had a colonoscopy 7 years ago that was remarkable for diverticula and a benign polyp in the sigmoid colon.

5. Basic colonoscopic & Polypectomy- 12 Case Scenarios

Training Objectives:

The Introduction to Colonoscopy module focuses on operating the colonoscope, navigating it through the entire colon, performing a visual examination of the colonic mucosa and identifying a variety of colorectal lesions. Cases are presented that require a thorough colonoscopy examination.

Upon completion of this module, the user will be able to:

  • Describe the anatomy of the colon pertinent to colonoscopy.
  • Demonstrate the operation of the colonoscope.
  • Perform a simulated colonoscopy examination.
  • Describe common colorectal lesions encountered during colonoscopy.
  • Discuss tips and techniques for overcoming common problems

 Case scenario- 12cases 

  • Family history of colorectal cancer who presents for routine screening. She is asymptomatic and her past medical history is unremarkable. Patient’s PE is unrevealing. Baseline vital signs are within normal limits. Patient reports no known drug allergies.
  • Sessile polyps in the ascending colon. Positive for occult blood in stool.
  • Surveillance colonoscopy. medical history includes diverticulosis. Bowel sounds are present.
  • Bright red blood in stools and rectal irritation for the past 3 weeks.
  • Increased urgency to defecate, has 4-6 loose bowel movements per day, mild-to-moderate lower abdominal cramps and intermittent blood in stool. The patient is afebrile.
  • Irregular bowel movements and constipation. Medical history includes laxative abuse.
  • Male presents for surveillance colonoscopy. His medical history is unremarkable, but thinks his uncle had colorectal cancer.
  • Patient presents for surveillance colonoscopy. He has an older brother who discovered he had polyps at 44-years of age.
  • Patient has a history of diabetes. primary physician performed a flexible sigmoidoscopy that revealed a pedunculated polyp in the descending colon.
  • Patient has a history of Crohn’s disease. She presents with 3 days of intermittent bloodless diarrhea and colicky abdominal pain in the RLQ. She is afebrile and physical examination is remarkable for mild RLQ tenderness on palpation.
  • Patient has a history of both diverticula and diminutive polyps in his sigmoid colon. His last colonoscopy was 3 years ago.
  • Patient presents with intermittent black-streaked stools. Physical examination is unremarkable except for positive fecal occult blood test.
  • Patient presents for colorectal cancer screening.
  • Patient presents for colorectal cancer screening. She is asymptomatic. Her family history is significant for father having polyps.
  • Patient with known diverticular disease. He undergoes screening every 5 years. No polyps have been detected on previous exams.      
  • Patient presents with intermittent painless rectal bleeding. Her family history is negative for colorectal cancer.
  • Patient presents with a chief complaint of fatigue. He has a recent history of small caliber stools.
  • Patient presents for her first colorectal cancer screening exam. Past medical history is significant for hysterectomy 15 years ago. Her family history is significant for polyps detected in 52 y.o. brother.

6. Case Capsule 10 Case Scenarios 

  • Patient undergoes initial screening flexible sigmoidoscopy.
  • Patient undergoes initial screening flexible sigmoidoscopy. She had a total abdominal hysterectomy 20 years ago for bleeding fibroids and has taken a calcium supplement and hormone-replacement therapy since the procedure.
  • Patient, who is a truck driver, undergoes flexible sigmoidoscopy because of intermittent bright red blood per rectum following long drives. He reports blood-streaked stools and blood on the toilet tissue.
  • Patient undergoes flexible sigmoidoscopy because of rectal bleeding that soils his underwear. He had a total colonoscopy 18 months ago because of heme-positive stool; no abnormalities were noted. Twelve months ago, he received a six week course of external-beam radiation therapy for prostate cancer.
  • Patient undergoes screening flexible sigmoidoscopy.
  • Patient undergoes flexible sigmoidoscopy because of increased stool frequency accompanied by crampy abdominal pain. She has irritable bowel syndrome and takes a selective serotonin re-uptake inhibitor (SSRI) for a mood disorder. The patient has had laparoscopic laser therapy for endometriosis on three occasions.
  • Patient undergoes initial screening flexible sigmoidoscopy. He has essential hypertension and type-2 diabetes mellitus that is controlled by diet and medication.
  • Patient undergoes initial screening flexible sigmoidoscopy. She takes thyroid replacement for hypothyroidism. Three test cards for fecal occult blood were negative.
  • Patient undergoes screening flexible sigmoidoscopy. A study five years ago was limited by poor colonic preparation. The patient has not complied with fecal occult blood testing.
  • Patient undergoes flexible sigmoidoscopy because of increased frequency and urgency of defecation and tenesmus. He is otherwise in good health and has no significant travel history.

Duration

6 Months

Certificate

Participants will be provided with a course completion certificate by D Y Patil University.

Fees

Rs. 2500/- per participant

Per Case Rs. 650/-

It includes

Introduction to simulator

Reading material

Selection of packages