Читать книгу Successful Training in Gastrointestinal Endoscopy - Группа авторов - Страница 4

1 Chapter 1Figure 1.1 An example of a typical apprenticeship contract in colonial Ameri...Figure 1.2 Roller demonstration model (1971): Homemade model showing alpha l...Figure 1.3 Hair dryer tube model (1972).Figure 1.4 St Mark’s/KeyMed model (1975): Commercially available with semire...Figure 1.5 Electronic targeting model (1975): Tested hand–eye coordination....Figure 1.6 Endoscopic Pong Game (1977): Tested hand–eye coordination.Figure 1.7 Imperial College/St Mark’s simulator (1980): Limited shaft insert...Figure 1.8 Imperial College/St Mark’s simulator MK2 (1985): Full shaft inser...Figure 1.9 (a) Novel ERCP endotrainer introduced by Joseph Leung, MD that al...Figure 1.10 (a) Artificial tissue colonoscopy “Phantom” simulator, U. of Tüb...Figure 1.11 (a) Compact‐EASIE porcine model hemostasis simulator. (b) Close‐...Figure 1.12 Immersion AccuTouch^® colonoscopy simulator.Figure 1.13 GI Mentor II (Simbionix) colonoscopy virtual reality simulator....Figure 1.14 Remote teaching of flexible endoscopy from New York to Kyabirwa,...

2 Chapter 2Figure 2.1 An example of a stepwise or “progressive” model of simulation‐bas...

3 Chapter 4Figure 4.1 Stages of endoscopy skill acquisitionFigure 4.2 “Preparation‐Training‐Wrap‐up” framework outlining the components...Figure 4.3 Set‐up of an endoscopy suite during training to optimize the trai...Figure 4.4 ACT model of performance enhancing feedback: Ask the trainee, Con...Figure 4.5 This image shows a common loop visualized with the assistance of ...

4 Chapter 5Figure 5.1 White light high‐resolution endoscopy (HRE) image of (a) early er...Figure 5.2 Long‐segment BE is evident on this low‐magnification white light ...Figure 5.3 Low‐magnification white light HRE image of normal gastric antrum ...Figure 5.4 Low‐magnification white light HRE image of normal fundus with two...Figure 5.5 Low‐magnification white light HRE image of normal duodenal bulb. ...Figure 5.6 White light HRE view of normal duodenal folds. The villiform arch...Figure 5.7 White light HRE view of (a) esophageal squamous cell carcinoma (S...Figure 5.8 Recommended grip technique for the endoscope with left index and ...Figure 5.9 (a) Upward tip deflection demonstrated with the thumb pushing the...Figure 5.10 White light HRE view showing erythema of the aryepiglottic folds...Figure 5.11 Angulation and hooking of the endoscope tip to aid with duodenal...Figure 5.12 (a) Mid‐esophageal cancer with luminal obstruction. (b) Subseque...Figure 5.13 Alternative hand position for ESD in which the index and middle ...Figure 5.14 Sample case from GI Mentor™.

5 Chapter 6Figure 6.1 Colon anatomy. This illustration demonstrates the anatomy of the ...Figure 6.2 Rectal anatomy. Just inside the anal sphincter muscles, the denta...Figure 6.3 Endoscopic view of the rectum. This endoscopic view shows the sem...Figure 6.4 Endoscopic view of the transverse colon. The transverse colon is ...Figure 6.5 Endoscopic view of the hepatic flexure. At the splenic and hepati...Figure 6.6 Endoscopic view of the cecum. This view of the cecum demonstrates...Figure 6.7 Endoscope options. Four different endoscopes can be used for lowe...Figure 6.8 How to hold the scope. These images demonstrate the proper manner...Figure 6.9 Scope dials. The colonoscope's dials are shown here. The large in...Figure 6.10 Scope valves. The top “red” valve activates the scope's suction ...Figure 6.11 Trap in suction circuit. When a polyp is removed with a snare, a...Figure 6.12 Rectal intubation techniques. This illustration demonstrates the...Figure 6.13 Torque to change from horizontal to vertical. The two images dep...Figure 6.14 One‐handed technique. With the one‐handed advancement technique,...Figure 6.15 Two‐handed technique. With the two‐handed technique, the right h...Figure 6.16 Lumen identification. When the lumen cannot be readily identifie...Figure 6.17 Retroflex views in rectum. Retroflexion in the rectum allows for...Figure 6.18 Some examples of key colonic abnormalities that trainees should ...Figure 6.19 Snare polypectomy. When a snare is required to remove a polyp, t...Figure 6.20 Looping causing perforation. In this sigmoid loop, the scope is ...Figure 6.21 Force vector. In this illustration, the tip of the scope is defl...Figure 6.22 Sigmoid loop. As the scope makes multiple turns in the sigmoid c...Figure 6.23 Alpha‐loop. One of the most common types of sigmoid loop formati...Figure 6.24 N‐loop. The N‐loop is also a common type of loop formation in th...Figure 6.25 Reverse alpha‐loop. A reverse alpha‐loop follows a similar confi...Figure 6.26 Transverse colon loop. Like the sigmoid, the transverse colon is...Figure 6.27 Acute turn. When attempting to navigate an acute turn, novices w...Figure 6.28 Torque to open folds. When less acute turns are encountered, the...Figure 6.29 Terminal ileum intubation. To intubate the ileocecal valve, the ...Figure 6.30 Incorrect TI maneuver. Like the acute turns, novice endoscopists...Figure 6.31 A trainee using a virtual reality colonoscopy simulator.Figure 6.32 A static mechanical model, the colonoscopy Erlangen active simul...Figure 6.33 Ex vivo models. In these images, harvested animal models are lai...Figure 6.34 An endoscopist practices on an ex vivo bovine colon model.Figure 6.35 Learning curves. Mayo's colonoscopy skills assessment tool (MCSA...

6 Chapter 7Figure 7.1 (a) Computerized EUS simulator (GI Mentor II, Simbionix Inc., Cle...Figure 7.2 EUS phantom images.Figure 7.3 (a) EASIE‐R EUS simulator. (b) Depicts a close‐up of the Easie‐R ...Figure 7.4 Depicts an EUS image produced from the EASIE‐R simulator.

7 Chapter 8Figure 8.1 Using one finger to control the air and suction button allows eas...Figure 8.2 Holding the ERCP scope with two fingers on the air and suction bu...Figure 8.3 A combination of 12 different scope maneuvers to position the cat...Figure 8.4 Tip of the papillotome can be used to change the orientation of t...Figure 8.5 An inflated balloon inside the bile duct can be used as a pivot t...Figure 8.6 Image of the Neo‐papilla model (a) and its cartoon schematic (b)....Figure 8.7 (a) EMS (ERCP mechanical simulator) allows in vitro practices wit...Figure 8.8 The Italian ERCP simulator model.

8 Chapter 9Figure 9.1 Small bowel capsule. Image courtesy of Olympus America Inc. and M...Figure 9.2 Upper gastrointestinal capsule. Medtronic, Inc.Figure 9.3 Colon capsule. Medtronic, Inc.Figure 9.4 Capsule endoscopy equipment (desktop computer, printer, recording...Figure 9.5 Jelly Bean test.Figure 9.6 PillCam™ patency capsule. Medtronic, Inc.Figure 9.7 AdvanCE^® device. Advanced Devices.Figure 9.8 Esophageal varices. Medtronic, Inc.Figure 9.9 Barrett’s esophagus. Medtronic, Inc.Figure 9.10 Suspected blood indicator (SBI). Medtronic, Inc.Figure 9.11 Study review in dual mode. Medtronic, Inc.Figure 9.12 Surface ulceration.Figure 9.13 Central umbilication.Figure 9.14 Lobulated mucosa.Figure 9.15 Bridging folds.

9 Chapter 10Figure 10.1 The Discovery SB overtube used in spiral enteroscopy is shown (a...Figure 10.2 Small‐bowel adaptation of tabletop ex vivo porcine model capable...

10 Chapter 11Figure 11.1 Close‐up of SpyScopeDS2^TM as it is attached to the duodenoscope....

11 Chapter 12Figure 12.1 The “Erbostat”: the first electrosurgical generator produced by ...Figure 12.2 The first “Bovie” generator designed by Bovie and Cushing in 192...Figure 12.3 The integration of art and science in electrosurgery.Figure 12.4 The spectrum of impedance of human tissue.Figure 12.5 The spectrum of frequencies of electromagnetic waves.Figure 12.6 (a) Monopolar circuit. (b) Bipolar circuit.Figure 12.7 Electrosurgical incision: the electrode is surrounded by a layer...Figure 12.8 Four incisions in ex vivo muscle produced with increasing voltag...Figure 12.9 (a) Argon plasma coagulation. (b) Contact coagulation with high ...Figure 12.10 Snare resection of a benign adenoma of the major papilla in the...Figure 12.11 (a) Cartoon of sphincterotome in papilla and sphincterotomy inc...Figure 12.12 Current flowing through an argon plasma during treatment of GAV...

12 Chapter 13Figure 13.1 Representative scout film obtained prior to ERCP. Note presence ...Figure 13.2 Fluoroscopic image in a patient with a mid‐to‐distal esophageal ...Figure 13.3 “Stricture‐gram” in a patient with colonic stenosis. Note narrow...Figure 13.4 Same patient as in Figure 13.3 following colonic stent placement...Figure 13.5 Representative fluoroscopic image obtained during a single‐ballo...Figure 13.6 Fluoroscopy during LAMS placement. (a) EUS access to a pancreati...

13 Chapter 14Figure 14.1 Assessing competency in pediatric colonoscopy should rely on a s...

14 Chapter 15Figure 15.1 Pit pattern classifications. (a) Type I: normal roundish pits. (...Figure 15.2 Lugol's iodine of squamous dysplasia showing white light on left...Figure 15.3 Squamous neoplasia in the esophagus demonstrating irregular dila...Figure 15.4 Narrowband images of Barrett's esophagus. (a) A nodular dysplasi...Figure 15.5 (a) Hyperplastic polyp white light (left) and NBI (right); tubul...

15 Chapter 16Figure 16.1 Stigmata of recent hemorrhage. (a) “Nipple sign” or platelet plu...Figure 16.2 Effect of changing patient position on gastric liquid. In the le...Figure 16.3 Single‐use sclerotherapy needles. Two different injector needles...Figure 16.4 Monopolar electrocautery. Current passes from the tip of the ele...Figure 16.5 Bipolar or multipolar electrocautery. Current passes around the ...Figure 16.6 (a) Argon plasma coagulation (APC). Non‐touch technique with AP...Figure 16.7 (a) Coaptive coagulation. Firm pressure (tamponade) to stop acti...Figure 16.8 (a) compactEASIE simulator hemostasis setup with rubber tubing s...

16 Chapter 17Figure 17.1 Demonstration of a TTS balloon in good position as verified by f...Figure 17.2 Picture from endoscopy video of one of the patients, showing bal...

17 Chapter 18Figure 18.1 Protective devices. (a) Transpharyngeal (top) and transesophagea...Figure 18.2 Diamond in the rough. This ingested diamond earing embedded in t...Figure 18.3 (a) Grasping instruments (top to bottom): four‐prong grasper, ra...Figure 18.4 Removal of a self‐expandable metallic stent (SEMS). Several atte...Figure 18.5 (a) Food bolus impaction. A partially chewed piece of chicken ob...Figure 18.6 Eosinophilic esophagitis. Corrugated rings represent one of the ...

18 Chapter 19Figure 19.1 Endoscopic “learning pyramid” for stepwise clinical skills acqui...Figure 19.2 Essential accessories for interventional endoscopy: CO₂ insuffla...Figure 19.3 (a, b) Endoscopic snare resection of a large 2.5 cm × 3 cm ampul...Figure 19.4 (a–e) Indigocarmine blue colorant for improved delineation of fl...Figure 19.5 (a–f) Cap resection (EMRc) for a flat “high‐grade intraepithelia...Figure 19.6 “Band and snare” mucosal resection kit (“Duette,” Cook Medical, ...Figure 19.7 Viscous substances are preferably used in ESD for creation of a ...Figure 19.8 (a, b) Professional monitoring and positioning of the patient du...Figure 19.9 (a) Transparent caps of different shapes and sizes significantly...Figure 19.10 Gastric ESD procedure supported by the use of an electric rolle...Figure 19.11 Eight different ESD cutting knifes are shown. The IT Knife (a),...Figure 19.12 Steps of endoscopic en bloc resection using submucosal dissecti...Figure 19.13 Endoscopic “en bloc” resection in submucosal dissection techniq...Figure 19.14 Widespread “en bloc” resection using ESD in the esophagus. (a, ...Figure 19.15 Endoscopic resection at the gastroesophageal junction. (a) Wide...Figure 19.16 Tools for adequate preparation of a mucosal specimen for histop...Figure 19.17 (a, b) An over‐the‐scope clip (OTSC; Ovesco, Tüebingen, Germany...Figure 19.18 (a–i) WHAT NOT TO DO: Difficult piecemeal snare resection of a ...Figure 19.19 (a) Hands‐on training in ESD using a pig specimen in the EASIE ...Figure 19.20 Possible strategy how to learn and establish endoscopic submuco...Figure 19.21 eFTR with FTRD^® (https://ovesco.com/ftrd‐system/colonic‐ft...Figure 19.22 Marking probe.Figure 19.23 Grasper.Figure 19.24 Clip/snare system with thread retriever.Figure 19.25 Assembly instruction (Oveso^®: OVE_FTRD System:Assembly she...Figure 19.26 Adenomatous polyp(Paris classification IIa LST granular‐nodular...Figure 19.27 Full thickness wall section with typical fried egg appearance....Figure 19.28 Full‐wall section stretched and pinned on cork plate.Figure 19.29 Application of the gastroduodenal FTRD^® (https://ovesco.co...Figure 19.30 OTSC© anchor (https://ovesco.com/otsc‐system/otsc‐anchor/).Figure 19.31 Small gastric carcinoma marked with clip.Figure 19.32 Guide wire introduction on endocope withdrawal.Figure 19.33 Intubation of the esophagus with balloon catheter over guide wi...Figure 19.34 Superficial mucosal tears after FTRD^®.Figure 19.35 Grasper application.Figure 19.36 Clip deployment before resection.Figure 19.37 Deep‐wall section with FTRD^® clip.Figure 19.38 Deep‐wall section with completely resected gastric carcinoma.Figure 19.39 OTSC to be removed.Figure 19.40 remOVE DC Cutter.Figure 19.41 remOVE DC Cutter application burst.Figure 19.42 Transsected slim part of OTSC.Figure 19.43 Cutting the opposite part of the OTSC.Figure 19.44 Disintegrated OTSC.Figure 19.45 Safe retrieval of OTSC fragment with remOVE Grasper and SecureC...Figure 19.46 Extracted OTSC half.

19 Chapter 20Figure 20.1 ERBE argon plasma coagulator being applied to a focal area of Ba...Figure 20.2 Circumferential radiofrequency ablation in long‐segment Barrett'...Figure 20.3 Focal radiofrequency ablation of a small residual island of Barr...Figure 20.4 Soft cap adjacent to the liquid nitrogen cryotherapy decompressi...Figure 20.5 Cryoballoon catheter, controller, and foot pedal controller with...

20 Chapter 21Figure 21.1 A 50 mm 0‐IIa+Is granualar rectal LSL. On careful inspection und...Figure 21.2 EMR of 35 mm 0‐IIa+Is non‐granular LSL in the transverse colon (...Figure 21.3 EMR of 50 mm 0‐IIa+Is granular LSL including optical evaluation ...Figure 21.4 Endoscopic mucosal resection. A sessile polyp with indented, but...Figure 21.5 Scar evaluation (a), with protocolized inspection identifying re...Figure 21.6 EMR of 40 mm hemi‐cirumferential 0‐IIa+Is granular rectal LSL (a...Figure 21.7 EMR of a 90% cirumferential 70 mm 0‐IIa+Is granular LSL (a–f).Figure 21.8 ESD for a large sessile rectal lesion. (a) Colonoscopy revealed ...Figure 21.9 A 45 mm 0‐IIa granular LSL (a). Status post‐EMR with snare tip s...Figure 21.10 The Sydney DMI classification. Type 0—normal post‐EMR defect (a...Figure 21.11 Endoscopic closure of perforation using hemoclips. A biopsy spe...

21 Chapter 23Figure 23.1 Mechanical simulator for purse‐string endoscopic suturing traini...Figure 23.2 Mechanical simulator for duodenal‐jejunal bypass liner (EndoBarr...Figure 23.3 1. Closure of esophageal defect using TTSCs. 2. A. Esophageal fi...Figure 23.4 Endoscopic balloon dilation training in ex vivo models. (a) Simu...Figure 23.5 Illustration showing the sclerotherapy technique.Figure 23.6 Illustration showing the argon plasma coagulation technique.Figure 23.7 Illustration showing the interrupted suture pattern.Figure 23.8 Purse‐string suturing of a GJA. (a) Dilated GJA. (b) 5‐ to 10‐mm...Figure 23.9 The Incisionless Operating Platform^TM (USGI Medical, San Clement...Figure 23.10 Several types of intragastric balloons. (a) “Fluid‐filled Ballo...

22 Chapter 24Figure 24.1 Mechanism of closure with clips compared to surgical suture clos...Figure 24.2 Technique of l decompression of tension pneumoperitoneum. (a) Te...Figure 24.3 Technique of circular perforation closure. Sequential steps in t...Figure 24.4 Technique of linear perforation closure. Sequential steps in the...Figure 24.5 (a–m) Endoscopic suturing closure of colonic perforation.

23 Chapter 25Figure 25.1 Endoscopes for stent placement in the gastrointestinal tract, fr...Figure 25.2 Currently available covered metal esophageal stents, from left t...Figure 25.3 Steps to be taken in stent placement for esophageal cancer. (a) ...Figure 25.4 Causes of recurrent dysphagia after esophageal stent placement. ...Figure 25.5 Example of one of the currently available lumen‐apposing metal s...Figure 25.6 A selection from the currently available enteral stents for use ...Figure 25.7 Steps to be taken in stent placement for gastric outlet obstruct...Figure 25.8 A selection from the currently available enteral stents for use ...

24 Chapter 26Figure 26.1 Initial cholangiogram fails to appreciate this large intrahepati...Figure 26.2 Trainees must learn to take steps to facilitate removal of large...Figure 26.3 Through‐the‐scope mechanical lithotripsy using a Trapezoid baske...Figure 26.4 LithoCrush V Mechanical Lithotripsy (Olympus America Inc., Cente...Figure 26.5 Salvage techniques for impacted baskets. (a) The Soehendra litho...Figure 26.6 Stones at risk for failure of mechanical lithotripsy. (a) A gian...Figure 26.7 Photo of the open Flower basket (top) next to standard stone ext...Figure 26.8 The use of large‐diameter papillary balloon dilation to extract ...Figure 26.9 EHL and laser probes ranging in diameter from 1–4Fr.Figure 26.10 This photo illustrates the stopcock coaxial system that attache...Figure 26.11 (a) Nortech AUTOLITH system (Northgaste Technologies Inc., Elgi...Figure 26.12 (a) Portable FREDDY Laser unit. (b) Application of laser to sto...Figure 26.13 LAMS view of gallstones.

25 Chapter 27Figure 27.1 Freehand 6‐Fr pediatric forceps biopsy of a low stricture at ERC...Figure 27.2 Forceps biopsy of a Bismuth IIIA tumor of the bifurcation using ...Figure 27.3 Small 6‐Fr forceps biopsy specimen on saline‐moistened pad—appro...Figure 27.4 Vigorous smashing of the forceps specimen between two dry glass ...Figure 27.5 Major types of SEMS.Figure 27.6 Appropriate stent lengths judged by the endoscope position.Figure 27.7 5‐cm radiopaque markers on a catheter placed just at the top of ...Figure 27.8 Anatomic distribution of the strictures was classified by Bismut...Figure 27.9 Stent‐thru‐a‐stent system by a South Korean company can achieve ...Figure 27.10 (a) Two 6 Fr introducers are in position prior to deployment of...Figure 27.11 Benign and malignant features can be recognized in this large a...Figure 27.12 Here the sphincterotomies and the pancreatic stent have been pl...

26 Chapter 28Figure 28.1 Schematic representation of (a) sphincter of Oddi, (b) demonstra...Figure 28.2 A modified triple‐lumen aspirating catheter.Figure 28.3 The duct entered during sphincter of Oddi manometry can be ident...Figure 28.4 (a) An abnormal station pull‐through at sphincter of Oddi manome...

27 Chapter 29Figure 29.1 Illustration of the mechanism of formation of an acute pancreati...Figure 29.2 Illustration of the mechanism of formation of a chronic pancreat...Figure 29.3 Illustration depicting organized pancreatic necrosis (walled‐off...Figure 29.4 CT of organized pancreatic necrosis. This collection occurred af...Figure 29.5 EUS‐guided drainage of pancreatic pseudocyst. (a) FNA needle has...Figure 29.6 EUS‐guided drainage. (a) Illustration of EUS‐guided puncture. (b...Figure 29.7 (a) Schematic of pancreatic duct leak into pseudocyst. (b) Illus...Figure 29.8 Pancreatic duct leak in setting of chronic pancreatitis. (a) Pan...

28 Chapter 30Figure 30.1 The pull‐PEG apparatus. The image shows a 24‐Fr polyurethane PEG...Figure 30.2 A commercial pull‐PEG kit. The kit contains a silicone PEG tube,...Figure 30.3 The pull‐PEG. (a) The endoscope is positioned in the stomach, a ...Figure 30.4 The push‐PEG. (a) The endoscope is positioned in the stomach, a ...Figure 30.5 The peel‐away sheath PEG. (a) The peel‐sheath. The T‐fastener ap...Figure 30.6 PEG assessment form.

29 Chapter 31Figure 31.1 Esophagus anatomy.Figure 31.2 Lower esophageal sphincter (LES) anatomy*.Figure 31.3 Shown is the lower esophageal sphincter (LES) enlarged to emphas...Figure 31.4 Normal primary peristalsis as assessed by high‐resolution manome...Figure 31.5 Conventional line plots esophageal manometry.Figure 31.6 Typical swallow pressure topography, also known as Clouse plots ...Figure 31.7 Upper esophageal sphincter (UES) and lower esophageal sphincter ...Figure 31.8 Pressure inversion point (PIP), inspiration (I), expiration (E)....Figure 31.9 Different metrics of high‐resolution esophageal pressure topogra...Figure 31.10 Premature contraction, distal latency less than 4.5 seconds wit...Figure 31.11 Stepwise approach to EPT analysis according to the Chicago Clas...Figure 31.12 Esophageal pressurization pattern. (a): Compartmentalized esoph...Figure 31.13 Contraction vigor. (a) Absent/failed peristalsis, (b) weak peri...Figure 31.14 Achalasia and hypercontractile (Jackhammer) esophagus. (a) Acha...Figure 31.15 Impedance panometry.Figure 31.16 Contractile and obstructing features of major esophageal motili...Figure 31.17 Endoflip™ device.Figure 31.18 Medications that should be discontinued prior to and during the...Figure 31.19 Tracing from the Wireless Motility Capsule recording.

30 Chapter 32Figure 32.1 This photo shows an ideal room with an adjustable bed and a good...Figure 32.2 A beveled disposable anoscope with a built‐in light makes examin...Figure 32.3 This is a kit I keep in my office for emergent decompression of ...Figure 32.4 This is a photograph of an external hemorrhoid. These commonly i...Figure 32.5 This is a grade 4 prolapsed and ulcerated internal hemorrhoid. G...Figure 32.6 Bleeding internal and external hemorrhoids. The prolapsing inter...Figure 32.7 This is a case of rectal prolapse not to be confused with hemorr...Figure 32.8 A careful peri‐anal exam revealed this peri‐anal ulcer which was...Figure 32.9 This is an acute thrombosed external hemorrhoid which is tender ...Figure 32.10 This is an anoscopic exam of the right anterior hemorrhoid show...Figure 32.11 This is an example of an in office banding device. They are dis...Figure 32.12 The infrared coagulation device is performed through an anoscop...Figure 32.13 This is the HET bipolar diathermy device which is used to coagu...Figure 32.14 Anal fissures are not always visible and are diagnosed mainly o...Figure 32.15 A high definition ARM catheter have multiple sensors that provi...Figure 32.16 The same catheter with a balloon that is inflated in the rectum...Figure 32.17 This shows a case of dyssynergia where when bearing down as in ...

31 Chapter 33Figure 33.1 Target sign indicating perforation after removal of colon polyp....Figure 33.2 (a) A 3 cm sigmoid polyp undergoing snare polypectomy. (b) Spurt...

32 Chapter 34Figure 34.1 Projection of the number of gastroenterologists corrected for po...Figure 34.2 General Gastroenterology Fellowship Match statistics.Figure 34.3 Advanced Endoscopy Fellowship Match statistics.

33 Chapter 35Figure 35.1 Gastric ESD performed by Dr. Fabian Emura (center), assisted by ...Figure 35.2 Ex‐vivo pig stomach model for ESD training. The specimen is plac...Figure 35.3 (a‐c) Hands‐on training in Uganda, 2016, by ROEYA training cente...Figure 35.4 (a‐c) Hands‐on training in Addis Ababa, Ethiopia, in 2019 by ROE...Figure 35.5 (a) Demonstration of LAMS simulator by trainer. (b) Cystic lesio...

34 Chapter 37Figure 37.1 (a) View of interior of current ASGE ITT Center showing several ...Figure 37.2 The new ASGE Institute for Training and Technology (IT&T). The n...

35 Chapter 38Figure 38.1 (a) ASGE IT&T Center, Downers Grove, IL. (b) ASGE IT&T Center Bi...

36 Chapter 39Figure 39.1 Benchmarking in colonoscopy. Individual and average cecal intuba...Figure 39.2 Benchmarking in ERCP. Individual and average biliary cannulation...Figure 39.3 Personal outcome benchmarking data for 2020 for one author [RV] ...