Page 166 - IJB-9-6

International Journal of Bioprinting 3D printing in gastroenterology

Table 2. 3D printing for endoscopic operation, education, and simulation
Author Year Application Image Data Image processing Output 3D printing software Printing machine Printing material Printing technique Model name Model size* Printing time Printing cost
source format software format
Lee et al. [65] 2018 Endoscopic biopsy CT DICOM 3D Slicer v.4.5.0 STL Netfabb professional Clone S270 & Clone Platinum silicone rubber FDM Stomach N/A N/A N/A
v.5 K300
Yang et al. [61] 2018 ERCP CT/MRI DICOM Mimics Innovation STL N/A ProJet 4500 Visijet C4 Spectrum Core N/A Hilar cholangiocarcinoma and bile duct N/A N/A N/A
Suite v17.0
Lee et al. [64] 2019 Endoscopic CT DICOM 3D Slicer v.4.5.0 STL Netfabb professional Form 2 Silicone SLA Stomach N/A N/A N/A
hemostasis v.5
Kwon et al. [67] 2020 ERCP CT N/A In-house software STL MeshLab and 3DM Tough-3.6 Silicone N/A Stomach and duodenum N/A N/A N/A
MeshMixer
Dhir et al. [109] 2015 EUS-guided MRI N/A N/A N/A N/A Viper SI2 PLC SLA Bile duct N/A N/A N/A
biliary drainage
Holt et al. [68] 2018 Endoscopic N/A N/A N/A N/A Solid Works 2014 Connex 260v Silicone rubber, polymer Polyjet Stomach, duodenal ampulla N/A N/A 1482 USD
ampullectomy resin

Abbreviations: CT, computed tomography; DICOM, digital imaging and communications in medicine; ERCP, endoscopic retrograde cholangiopan-
creatography; FDM, fused deposition modeling; MRI, magnetic resonance imaging; PLC, polycarbonate; SLA, stereo lithography appearance; STL,
stereolithography; *refers to the percentage of lifesize organs.

phantoms of different phases , device for sutureless end operation time, and increased training costs. Experienced
[58]
enterostomy , and multisteerable configurations for endoscopists usually have higher overall resection rates,
[59]
laparoscopy (Figure 2B) . These are listed in Table 3. shorter operative times, and fewer adverse events .
[60]
[63]
Adequate training models of different GI disease scenarios,
3. 3D printing in gastrointestinal which are often difficult in real clinical settings, are needed
endoscopy to train less-experienced learners. Therefore, simulator-
based endoscopy training has been widely used and
Similar to open surgery or laparoscopic surgery, 3D validated over the past few decades.
printing also facilitates GI endoscopy in preoperative
planning and guidance (Table 2), education (Table 2), and Lee et al. created a new 3DP stomach hemostatic
accessory production (Table 3). simulator with two hemostasis modules for hemoclipping
and injection, which can effectively train beginners in GI
3.1. Preoperative planning and guidance hemostatic skills . They also created a 3DP gastric biopsy
[64]
Yang et al. reported that the 3DP model could simulator that could improve biopsy skills . For advanced
[65]
accurately display hilar cholangiocarcinoma (HCC) endoscopic techniques such as endoscopic retrograde
and its relationship with the surrounding bile duct, cholangiopancreatography (ERCP), anatomical differences,
which could be used to guide endoscopic retrograde realistic sense, and durability are major concerns for
cholangiopancreatography (ERCP) in HCC patients and simulation . Kwon et al. optimized the ERCP model using
[66]
improve the success rate . Recently, our team updated the 3DP technique, which helped learners successfully
[61]
the concept of endoscopic submucosal dissection (ESD) and repeatedly complete basic biliary intubation, difficult
based on 3DP (Figure 2C). A large esophageal submucosal intubation, stone extraction, mechanical lithotomy, stent
tumor was successfully removed by endoscopy under the implantation, and balloon dilation . Should ERCP fail,
[67]
guidance of the 3DP model, which can distinctly display a printed biliary duct prototype could also be used for
the tumor anatomy and details of important adjacent training and practicing endoscopic ultrasound (EUS)-
organs such as the bronchus, aorta, and spine . guided biliary drainage. Endoscopic ampullectomy is
[62]
another technically challenging procedure. The effect of a
3.2. Education 3DP endoscopic ampullectomy training model has been
Endoscopy is an important tool for the diagnosis and preliminarily confirmed, which may solve the problem of
treatment of digestive diseases, but it is a challenging limited training opportunities .
[68]
technique that requires extensive training. Traditionally,
novices learn basic endoscopic skills under the guidance 3.3. 3D-printed endoscopic accessories
of experienced endoscopists. Although this provides direct Similar to surgical applications, 3DP is equally useful in
supervision and real-time evaluation by instructors, it producing endoscopic accessories. Zizer et al. developed
may inadvertently lead to patient discomfort, prolonged a 3DP overtube system and confirmed its efficacy in

Volume 9 Issue 6 (2023) 158 https://doi.org/10.36922/ijb.0149