Original title: Bethesda Endoscopic Retrograde Cholangiopancreatography Skill Assessment Tool (BESAT)-Based Simulator Training Using a Novel Dry Endoscopic Retrograde Cholangiopancreatography Model Improves Technical Proficiency and Self-Efficacy: A Prospective Study
Yutaka Hatayama, Takeshi Kanno, Tetsuya Takikawa, Ryotaro Matsumoto +6 · September 2026
Cutting a small muscle opening during an internal gut exam, called an endoscopic sphincterotomyA surgical cut made through an endoscope to open the bile duct opening, often to remove stones., is risky and hard to learn. Doctors can cause dangerous bleeding if they make the wrong cut. To help doctors practice safely, researchers tested a training program using a dry simulator that mimics bleeding if an incision goes wrong. Trainees watched an instructional video, tried the procedure on the model, received expert feedback focused on six technical tips, and then tried the procedure a second time. The model showed them immediately if their cut was the right size and angle without causing bleeding. The training worked. Trainees nearly doubled their success rate, jumping from 43.3% to 76.7% successful cuts after receiving feedback. Their confidence and understanding also rose sharply and stayed high three months later. Having completed over 50 real past cases also helped doctors succeed on their first try.
Imagine learning to cut a cake so the icing doesn't tear. Every bad cut ruins the look, and you only see the mistake after it's done. You practice on a fake cake that shows every flaw immediately. A friend watches and tells you exactly how to adjust your angle and pressure. After one session, your cuts are much cleaner. Here, the fake cake is a dry model of the bile duct opening, the ruined icing is simulated bleeding from a wrong cut, and the friends advice is the structured feedback based on the BESAT framework.
ERCP is a procedure for treating bile duct blockages. The critical step, endoscopic sphincterotomy, is risky—a poor incision can cause bleeding. This study shows that training on a dry model that bleeds when cut wrong, paired with targeted feedback, nearly doubled success rates. For patients, that means fewer complications.
This study was non-randomized and single-center with only 30 trainees, limiting generalizability. The improvement in stone removal (33.3% to 60.0%) was not statistically significant (p=0.07). The analysis linking prior experience to success was post-hoc. Long-term retention beyond three months was not assessed, and the simulator only models bleeding, not other complications like perforation.
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Bethesda Endoscopic Retrograde Cholangiopancreatography Skill Assessment Tool (BESAT)-Based Simulator Training Using a Novel Dry Endoscopic Retrograde Cholangiopancreatography Model Improves Technical Proficiency and Self-Efficacy: A Prospective Study — Yutaka Hatayama, Takeshi Kanno, Tetsuya Takikawa et al. — DEN open — doi:10.1002/deo2.70382
Abstract licence: CC BY
Explanation generated by Synthesis from the abstract — it is not the original paper.