New methods of teaching the axis in ERCP: Can I write my name?

ERCP is among the most difficult procedures in gastrointestinal endoscopy. In fact, as testified by P. B. Cotton in the 1960s to the 1970s, ERCP was “difficult to overstate,” and it still is today. Learning ERCP demands patience, skills, and an understanding of cholangiopancreatographic anatomy and imaging interpretation, as well as the ability to gain the cannulation axis and choose the adequate accessories. We conducted an experiment to teach how to gain the correct axis in front of the papilla, including coordination of the wheels, the elevator, and the shaft. We used the Boskoski- Costamagna ERCP Trainer. The papilla was removed and replaced by a piece of paper. A handmade ERCP writing accessory was made Using coordinated circular and straight movements of the big and small wheels and the shaft of the endoscope, and coordinated movements of the elevator, we easily managed to write the word “ERCP.”