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Overbeek KA, Cahen DL, Bruno MJ. The role of endoscopic ultrasound in the detection of pancreatic lesions in high-risk individuals. Fam Cancer 2024; 23:279-293. [PMID: 38573399 PMCID: PMC11255057 DOI: 10.1007/s10689-024-00380-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 03/17/2024] [Indexed: 04/05/2024]
Abstract
Individuals at high risk of developing pancreatic ductal adenocarcinoma are eligible for surveillance within research programs. These programs employ periodic imaging in the form of magnetic resonance imaging/magnetic resonance cholangiopancreatography or endoscopic ultrasound for the detection of early cancer or high-grade precursor lesions. This narrative review discusses the role of endoscopic ultrasound within these surveillance programs. It details its overall strengths and limitations, yield, burden on patients, and how it compares to magnetic resonance imaging. Finally, recommendations are given when and how to incorporate endoscopic ultrasound in the surveillance of high-risk individuals.
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Affiliation(s)
- Kasper A Overbeek
- Erasmus MC Cancer Institute, Department of Gastroenterology & Hepatology, University Medical Center Rotterdam, Rotterdam, The Netherlands.
| | - Djuna L Cahen
- Erasmus MC Cancer Institute, Department of Gastroenterology & Hepatology, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marco J Bruno
- Erasmus MC Cancer Institute, Department of Gastroenterology & Hepatology, University Medical Center Rotterdam, Rotterdam, The Netherlands
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2
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Miutescu B, Dhir V. Training and quality indicators in interventional endoscopic ultrasound. Dig Endosc 2024. [PMID: 39021062 DOI: 10.1111/den.14881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 06/18/2024] [Indexed: 07/20/2024]
Abstract
Endoscopic ultrasound (EUS) has transformed the landscape of minimally invasive gastrointestinal procedures, necessitating specialized training for proficiency in interventional EUS (iEUS). This study evaluates the effectiveness of iEUS training, focusing on learning curves, success rates, and the associated risks in various procedures, aiming to recommend practices for standardizing training and ensuring competency. Key metrics such as procedure type, learning curve for proficiency, success rates, and risk of adverse events were analyzed to establish benchmarks for training programs. Proficiency in pancreatic fluid collection drainage was achieved after 20-30 procedures, with a 100% success rate and a complication rate ranging from 1.5 to 80%. Gallbladder drainage required 19 cases to reach an 86% success rate, with adverse events reported in 19% of cases. Choledocoduodenostomy mastery was observed after approximately 100 cases, with postintervention pancreatitis affecting 5.3-6.6% of all cases. Hepaticogastrostomy showed a 93% success rate after 33 cases, with a 24.8% adverse event rate. Hepaticoenterostomy reached 100% success beyond the 40th patient, with a 20% rate of postsurgical strictures. Pancreatic duct drainage achieved 89% technical and 87% clinical success after 27 cases, with 12-15% adverse events. Gastro-enteric anastomosis required 25 cases for proficiency and approximately 40 cases for mastery, with 5.5% immediate and 1% late adverse events. iEUS training outcomes vary significantly across different procedures, highlighting the importance of structured, procedure-specific training programs to achieve proficiency. These findings provide a foundation for developing universal competency benchmarks in iEUS, facilitating consistent and effective training worldwide.
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Affiliation(s)
- Bogdan Miutescu
- Department of Gastroenterology and Hepatology, "Victor Babeş" University of Medicine and Pharmacy, Timisoara, Romania
| | - Vinay Dhir
- Institute of Digestive and Liver Care, SL Raheja Hospital, Mumbai, India
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3
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Wani S, Cote GA, Keswani RN, Yadlapati RH, Hall M, O'Hara J, Berzin TM, Burbridge RA, Chahal P, Cohen J, Coyle WJ, Early D, Guda NM, Inamdar S, Khanna L, Kulkarni A, Rosenkranz L, Sharma N, Shin EJ, Siddiqui UD, Sinha J, Vanderveldt H, Draganov PV. Development of American Society for Gastrointestinal Endoscopy standards for training in advanced endoscopy within dedicated advanced endoscopy fellowship programs. Gastrointest Endosc 2024:S0016-5107(24)00186-X. [PMID: 38935016 DOI: 10.1016/j.gie.2024.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 03/18/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND AND AIMS Training in interventional endoscopy is offered by nonaccredited advanced endoscopy fellowship programs (AEFPs). The number of these programs has increased dramatically with a concurrent increase in the breadth and complexity of interventional endoscopy procedures. Accreditation is governed by competency-based education, yet what constitutes a "high-quality" nonaccredited AEFP has not been defined. Using an evidence-based consensus process, we aimed to establish standards for AEFPs. METHODS The RAND UCLA appropriateness method, a well-described modified Delphi process to develop quality indicators, was used. A task force established by the American Society for Gastrointestinal Endoscopy drafted potential quality indicators (structure, process, and outcome) in 6 categories: activity preceding training; structure of AEFPs; training in ERCP, EUS, and EMR; and luminal stent placement. Three rounds of iterative feedback from 20 experts were conducted. Round 0 involved discussion of project details. In round 1, experts independently ranked proposed quality indicators on a 9-point interval scale ranging from highly inappropriate (1) to highly appropriate (9). Next, proposed quality indicators were discussed and reworded in a group meeting followed by round 2, in which experts independently reranked proposed quality indicators and provided benchmarks (when applicable). The median score for each quality indicator was calculated. Mean absolute deviation from the median was calculated, and appropriateness of potential quality indicators was assessed using the BIOMED concerted action on appropriateness definition, P value method, and interpercentile range adjusted for symmetry definition. A quality indicator was deemed appropriate if the median score was ≥7 and met criteria for appropriateness using all 3 defined statistical methods. RESULTS Of 89 proposed quality indicators, 37 statements met criteria as appropriate for a quality indicator (activity preceding training, 2; structure of AEFPs, 10; training in ERCP, 7; training in EUS, 8; training in EMR, 7; luminal stent placement, 3). Minimum thresholds were defined for 19 relevant quality indicators for number of trainers, procedures during fellowship, and procedures before assessment of competence. Among the final appropriate quality indicators were that all trainees should undergo qualitative and quantitative competence assessments using validated tools at least quarterly with documented feedback throughout the training period and that trainees should track outcomes and relevant quality metrics for specific procedures. CONCLUSIONS This consensus process using validated methodology established standards for an AEFP in an effort to ensure adequate training in the most commonly taught interventional endoscopic procedures (ERCP, EUS, EMR, and luminal stent placement) during fellowship. An important component of an AEFP is the use of competency-based assessments that are compliant with the Accreditation Council for Graduate Medical Education's Next Accreditation System, with the goal of ensuring that trainees achieve specific milestones in their progression to achieving cognitive and technical competency.
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Affiliation(s)
- Sachin Wani
- Division of Gastroenterology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Gregory A Cote
- Division of Gastroenterology, Oregon Health & Science University, Portland, Oregon, USA
| | - Rajesh N Keswani
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Rena H Yadlapati
- UCSD Center for Esophageal Diseases, Division of Gastroenterology, University of California San Diego, La Jolla, California, USA
| | - Matt Hall
- Children's Hospital Association, Lenexa, Kansas, USA
| | - Jack O'Hara
- Division of Gastroenterology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Tyler M Berzin
- Beth Israel Deaconess Medical Center, Division of Gastroenterology, Harvard Medical School, Boston, Massachusetts, USA
| | - Rebecca A Burbridge
- Division of Gastroenterology, Duke University Medical Center, Durham, North Carolina, USA
| | - Prabhleen Chahal
- Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jonathan Cohen
- New York University Grossman School of Medicine, New York, New York, USA
| | - Walter J Coyle
- Division of Gastroenterology, Scripps Green Hospital, La Jolla, California, USA
| | - Dayna Early
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Nalini M Guda
- Aurora St Luke's Medical Center, Milwaukee, Wisconsin, USA
| | - Sumant Inamdar
- Division of Gastroenterology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Lauren Khanna
- Department of Medicine, New York University Langone Health, New York, New York, USA
| | - Abhijit Kulkarni
- Division of Gastroenterology and Hepatology, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Laura Rosenkranz
- Division of Gastroenterology, Hepatology, and Nutrition, University of Texas Health, San Antonio, Texas, USA
| | - Neil Sharma
- Division of Interventional Endoscopic Oncology and Surgical Endoscopy, Parkview Health, Fort Wayne, Indiana, USA
| | - Eun Ji Shin
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Uzma D Siddiqui
- Center for Endoscopic Research and Therapeutics (CERT), University of Chicago, Chicago, Illinois, USA; 20Division of Gastroenterology, Northwestern University, Chicago, Illinois, USA
| | - Jasmine Sinha
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Hendrikus Vanderveldt
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Peter V Draganov
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Florida, Gainesville, Florida, USA
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Chalhoub JM, Hawa F, Grantham T, Lester J, Carpenter ES, Mendoza-Ladd A, Wani S, Machicado JD. Effect of the number of passes on diagnostic performance of EUS fine-needle biopsy of solid pancreatic masses: a systematic review and meta-analysis. Gastrointest Endosc 2024:S0016-5107(24)03258-9. [PMID: 38852683 DOI: 10.1016/j.gie.2024.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 04/02/2024] [Accepted: 05/29/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND AND AIMS The optimal number of passes to maximize the diagnostic ability of EUS fine-needle biopsy (FNB) of solid pancreatic masses (SPMs) is not well known. We conducted a systematic review to evaluate the impact of the incremental number of passes on diagnostic accuracy, tissue adequacy, and diagnostic yield for EUS-FNB of SPMs. METHODS We searched MEDLINE, Embase, Scopus, and Cochrane Central for randomized controlled trials comparing per-pass diagnostic outcomes of FNB needles in patients with SPMs. Meta-analysis was conducted using random-effects models. A separate analysis was performed on studies that used contemporary Franseen and fork-tip needles. RESULTS Overall, 19 randomized controlled trials (N = 3552) were identified. For EUS-FNB of SPMs, 3 passes with any FNB needle outperformed 2 passes for accuracy (odds ratio [OR], 1.58; 95% confidence interval [CI], 1.20-2.09; I2 = 0%), adequacy (OR, 1.97; 95% CI, 1.30-2.83; I2 = 61%), and yield (OR, 2.12; 95% CI, 1.37-3.27; I2 = 14%). Adding a fourth or fifth pass resulted in no significant improvement in diagnostic parameters. When using contemporary FNB needles, adding a second to a single pass significantly improved accuracy (OR, 1.80; 95% CI, 1.23-2.63; I2 = 0%), adequacy (OR, 2.19; 95% CI, 1.65-2.90; I2 = 0%), and yield (OR, 2.72; 95% CI, 1.50-4.95; I2 = 0%). Adding a third pass to a second pass with contemporary needles improved adequacy (OR, 2.96; 95% CI, 1.97-4.46; I2 = 0%) but did not provide better diagnostic accuracy or yield. CONCLUSIONS Two passes with Franseen or Fork-tip needles and 3 passes with any FNB needle suffice to provide optimal diagnostic performance for EUS-FNB of SPMs, without additional diagnostic benefits with more passes. Our results can inform future guidelines and quality benchmarks.
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Affiliation(s)
- Jean M Chalhoub
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Staten Island University Hospital, Northwell Health, Staten Island, New York, USA
| | - Fadi Hawa
- Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA
| | - Tyler Grantham
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Staten Island University Hospital, Northwell Health, Staten Island, New York, USA
| | - Janice Lester
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Staten Island University Hospital, Northwell Health, Staten Island, New York, USA
| | - Eileen S Carpenter
- Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA
| | - Antonio Mendoza-Ladd
- Division of Gastroenterology and Hepatology, University of California-Davis, Sacramento, California, USA
| | - Sachin Wani
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
| | - Jorge D Machicado
- Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA.
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Sekine K, Nagata N, Hisada Y, Yamamoto K, Mukai S, Tsuchiya T, Machitori A, Kojima Y, Yada T, Yamamoto N, Uemura N, Itoi T, Kawai T. Identifying predictors for comorbidities related mortality versus pancreatic cancer related mortality in patients with intraductal papillary mucinous neoplasm. United European Gastroenterol J 2024; 12:614-626. [PMID: 38367226 PMCID: PMC11176910 DOI: 10.1002/ueg2.12540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 12/11/2023] [Indexed: 02/19/2024] Open
Abstract
BACKGROUNDS Few data are available for surveillance decisions focusing on factors related to mortality, as the primary outcome, in intraductal papillary mucinous neoplasm (IPMN) patients. AIMS We aimed to identify imaging features and patient backgrounds associated with mortality risks by comparing pancreatic cancer (PC) and comorbidities. METHODS We retrospectively conducted a multicenter long-term follow-up of 1864 IPMN patients. Competing risk analysis was performed for PC- and comorbidity-related mortality. RESULTS During the median follow-up period of 5.5 years, 14.0% (261/1864) of patients died. Main pancreatic duct ≥5 mm and mural nodules were significantly related to all-cause and PC-related mortality, whereas cyst ≥30 mm did not relate. In 1730 patients without high-risk imaging features, 48 and 180 patients died of PC and comorbidity. In the derivation cohort, a prediction model for comorbidity-related mortality was created, comprising age, cancer history, diabetes mellitus complications, chronic heart failure, stroke, paralysis, peripheral artery disease, liver cirrhosis, and collagen disease in multivariate analysis. If a patient had a 5 score, 5- and 10-year comorbidity-related mortality is estimated at 18.9% and 50.2%, respectively, more than 7 times higher than PC-related mortality. The model score was also significantly associated with comorbidity-related mortality in a validation cohort. CONCLUSIONS This study demonstrates main pancreatic duct dilation and mural nodules indicate risk of PC-related mortality, identifying patients who need periodic examination. A comorbidity-related mortality prediction model based on the patient's age and comorbidities can stratify patients who do not require regular tests, especially beyond 5 years, among IPMN patients without high-risk features. CLINICAL TRIAL REGISTRATION T2022-0046.
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Affiliation(s)
- Katsunori Sekine
- Department of Gastroenterology and HepatologyNational Center for Global Health and MedicineKohnodai HospitalIchikawaChibaJapan
| | - Naoyoshi Nagata
- Department of Gastroenterological EndoscopyTokyo Medical UniversityTokyoJapan
| | - Yuya Hisada
- Department of Gastroenterology and HepatologyNational Center for Global Health and MedicineTokyoJapan
| | - Kenjiro Yamamoto
- Department of Gastroenterology and HepatologyTokyo Medical UniversityTokyoJapan
| | - Shuntaro Mukai
- Department of Gastroenterology and HepatologyTokyo Medical UniversityTokyoJapan
| | - Takayoshi Tsuchiya
- Department of Gastroenterology and HepatologyTokyo Medical UniversityTokyoJapan
| | - Akihiro Machitori
- Department of RadiologyNational Center for Global Health and MedicineKohnodai HospitalIchikawaChibaJapan
| | - Yasushi Kojima
- Department of Gastroenterology and HepatologyNational Center for Global Health and MedicineTokyoJapan
| | - Tomoyuki Yada
- Department of Gastroenterology and HepatologyNational Center for Global Health and MedicineKohnodai HospitalIchikawaChibaJapan
| | - Natsuyo Yamamoto
- Department of Gastroenterology and HepatologyNational Center for Global Health and MedicineTokyoJapan
| | - Naomi Uemura
- Department of Gastroenterology and HepatologyNational Center for Global Health and MedicineKohnodai HospitalIchikawaChibaJapan
| | - Takao Itoi
- Department of Gastroenterology and HepatologyTokyo Medical UniversityTokyoJapan
| | - Takashi Kawai
- Department of Gastroenterological EndoscopyTokyo Medical UniversityTokyoJapan
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Vila JJ, Jusué Irurita V, Rullán Iriarte M. Is ERCP still the elective primary biliary drainage technique in patients with malignant distal biliary obstruction? REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2024; 116:182-185. [PMID: 38095214 DOI: 10.17235/reed.2023.10029/2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) has been established as the first line therapy for the resolution of biliary and pancreatic diseases. The main disadvantage of the procedure is the rate of adverse events, around 10%1. So, despite being a minimally invasive procedure, ERCP has a non-negligible rate of adverse effects (AEs) and secondary mortality.
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Affiliation(s)
- Juan J Vila
- Endoscopy Unit. Gastroenterology Department, Hospital Universitario de Navarra, España
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Teles de Campos S, Arvanitaki M, Boskoski I, Deviere J. Vade Mecum in ERCP, a roadmap to success: Tips from experts for excelling in ERCP. Endosc Int Open 2024; 12:E613-E620. [PMID: 38681145 PMCID: PMC11052645 DOI: 10.1055/a-2290-1479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/12/2023] [Indexed: 05/01/2024] Open
Abstract
Background and study aims Training in endoscopic retrograde cholangiopancreatography (ERCP) is operator-dependent and traditionally, the apprenticeship model, in which experts are considered to be role models, has been adopted for it. The aim of this study was to develop a practical guide compiling tips from experts to help guide trainees to succeed in ERCP. Methods A web-based survey was created to understand the professional development of ERCP experts, the investments they made, the obstacles they overcame, and the quotes that guided their professional life. ERCP experts worldwide were invited to participate. Results Fifty-three experts (of 71; 74.6%) from 24 countries answered the survey. Experts started ERCP training early (average age 31 years; range, 24-52 years) and it often was combined with training for endoscopic ultrasound. A long training period (average 21 months; range, 3-120 months) was needed to achieve competence, frequently in another department, and it was commonly complemented with research in the field (76.5%). "Time and practice" were the most worthwhile investments they made to achieve success. "Sports" were an area outside endoscopy frequently considered to be important to acquire the skills necessary to excel in ERCP. "Lack of dedicated time for training" and "peer competition" were the biggest obstacles the experts faced. Several pieces of advice were given to the experts, such as to be resilient, careful, patient, responsible, and hard-working. "Personal life" was mentioned as an undeniably crucial factor for achieving long-term success that should not be forgotten. Conclusions This survey is the first to provide insight regarding the professional trajectory of renowned ERCP experts worldwide, providing valuable recommendations to help trainees excel in ERCP.
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Affiliation(s)
- Sara Teles de Campos
- Université Libre de Bruxelles, Bruxelles, Belgium
- Gastroenterology department, Digestive Unit, Champalimaud Foundation, Lisbon, Portugal
- Fondation Michel Cremer, Bruxelles, Belgium
| | - Marianna Arvanitaki
- Université Libre de Bruxelles, Bruxelles, Belgium
- Service de Gastroentérologie, d’Hépato-Pancréatologie et d’Oncologie digestive, Hôpital Erasme, Bruxelles, Belgium
| | - Ivo Boskoski
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Jacques Deviere
- Université Libre de Bruxelles, Bruxelles, Belgium
- Gastroenterology department, Digestive Unit, Champalimaud Foundation, Lisbon, Portugal
- Fondation Michel Cremer, Bruxelles, Belgium
- Service de Gastroentérologie, d’Hépato-Pancréatologie et d’Oncologie digestive, Hôpital Erasme, Bruxelles, Belgium
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Stefanovic S, Adler DG, Arlt A, Baron TH, Binmoeller KF, Bronswijk M, Bruno MJ, Chevaux JB, Crinò SF, Degroote H, Deprez PH, Draganov PV, Eisendrath P, Giovannini M, Perez-Miranda M, Siddiqui AA, Voermans RP, Yang D, Hindryckx P. International Consensus Recommendations for Safe Use of LAMS for On- and Off-Label Indications Using a Modified Delphi Process. Am J Gastroenterol 2024; 119:671-681. [PMID: 37934190 DOI: 10.14309/ajg.0000000000002571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/02/2023] [Indexed: 11/08/2023]
Abstract
INTRODUCTION The study aimed to develop international consensus recommendations on the safe use of lumen-apposing metal stents (LAMSs) for on- and off-label indications. METHODS Based on the available literature, statements were formulated and grouped into the following categories: general safety measures, peripancreatic fluid collections, endoscopic ultrasound (EUS)-biliary drainage, EUS-gallbladder drainage, EUS-gastroenterostomy, and gastric access temporary for endoscopy. The evidence level of each statement was determined using the Grading of Recommendations Assessment, Development, and Evaluation methodology.International LAMS experts were invited to participate in a modified Delphi process. When no 80% consensus was reached, the statement was modified based on expert feedback. Statements were rejected if no consensus was reached after the third Delphi round. RESULTS Fifty-six (93.3%) of 60 formulated statements were accepted, of which 35 (58.3%) in the first round. Consensus was reached on the optimal learning path, preprocedural imaging, the need for airway protection and essential safety measures during the procedure, such as the use of Doppler, and measurement of the distance between the gastrointestinal lumen and the target structure. Specific consensus recommendations were generated for the different LAMS indications, covering, among others, careful patient selection, the preferred size of the LAMS, the need for antibiotics, the preferred anatomic location of the LAMS, the need for coaxial pigtail placement, and the appropriate management of LAMS-related adverse events. DISCUSSION Through a modified international Delphi process, we developed general and indication-specific experience- and evidence-based recommendations on the safe use of LAMS.
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Affiliation(s)
- Sebastian Stefanovic
- Department of Gastroenterology, Ghent University Hospital, Ghent, Belgium
- Diagnostic Center Bled Group, Bled, Slovenia
| | - Douglas G Adler
- Centura Health, Center for Advanced Therapeutic Endoscopy, Colorado, Englewood, USA
| | - Alexander Arlt
- Department of Internal Medicine and Gastroenterology, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Todd H Baron
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Kenneth F Binmoeller
- Interventional Endoscopy Services, California Pacific Medical Center, San Francisco, California, USA
| | - Michiel Bronswijk
- Gastroenterology and Hepatology, Imelda Hospital Bonheiden and University Hospitals Leuven, Belgium
| | - Marco J Bruno
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | | | - Stefano Francesco Crinò
- Department of Medicine, Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, University Hospital of Verona, Verona, Italy
| | - Helena Degroote
- Department of Gastroenterology, Ghent University Hospital, Ghent, Belgium
| | - Pierre H Deprez
- Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Department of Hepatogastroenterology, Brussels, Belgium
| | | | - Pierre Eisendrath
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Saint-Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Marc Giovannini
- Digestive Endoscopy Unit, Paoli Calmettes Institute, Marseille Cedex 9, France
| | - Manuel Perez-Miranda
- Gastroenterology Department, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Ali A Siddiqui
- Department of Gastroenterology and Hepatology, Inova Fairfax Hospital, Falls Church, Virginia, USA
| | - Rogier P Voermans
- Amsterdam University Medical Center, Department of Gastroenterology and Hepatology, University of Amsterdam, Amsterdam, Netherlands
| | - Dennis Yang
- Center for Interventional Endoscopy, AdventHealth, Orlando, Florida, USA
| | - Pieter Hindryckx
- Department of Gastroenterology, Ghent University Hospital, Ghent, Belgium
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9
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Badaoui A, Teles de Campos S, Fusaroli P, Gincul R, Kahaleh M, Poley JW, Sosa Valencia L, Czako L, Gines A, Hucl T, Kalaitzakis E, Petrone MC, Sadik R, van Driel L, Vandeputte L, Tham T. Curriculum for diagnostic endoscopic ultrasound training in Europe: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy 2024; 56:222-240. [PMID: 38065561 DOI: 10.1055/a-2224-8704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
The European Society of Gastrointestinal Endoscopy (ESGE) has recognized the need to formalize and enhance training in diagnostic endoscopic ultrasound (EUS). This manuscript represents the outcome of a formal Delphi process resulting in an official Position Statement of the ESGE and provides a framework to develop and maintain skills in diagnostic EUS. This curriculum is set out in terms of the prerequisites prior to training; the recommended steps of training to a defined syllabus; the quality of training; and how competence should be defined and evidenced before independent practice. 1: Trainees should have achieved competence in upper gastrointestinal endoscopy before training in diagnostic EUS. 2: The development of diagnostic EUS skills by methods that do not involve patients is advisable, but not mandatory, prior to commencing formal training in diagnostic EUS. 3: A trainee's principal trainer should be performing adequate volumes of diagnostic EUSs to demonstrate maintenance of their own competence. 4: Training centers for diagnostic EUS should offer expertise, as well as a high volume of procedures per year, to ensure an optimal level of quality for training. Under these conditions, training centers should be able to provide trainees with a sufficient wealth of experience in diagnostic EUS for at least 12 months. 5: Trainees should engage in formal training and supplement this with a range of learning resources for diagnostic EUS, including EUS-guided fine-needle aspiration and biopsy (FNA/FNB). 6: EUS training should follow a structured syllabus to guide the learning program. 7: A minimum procedure volume should be offered to trainees during diagnostic EUS training to ensure that they have the opportunity to achieve competence in the technique. To evaluate competence in diagnostic EUS, trainees should have completed a minimum of 250 supervised EUS procedures: 80 for luminal tumors, 20 for subepithelial lesions, and 150 for pancreaticobiliary lesions. At least 75 EUS-FNA/FNBs should be performed, including mostly pancreaticobiliary lesions. 8: Competence assessment in diagnostic EUS should take into consideration not only technical skills, but also cognitive and integrative skills. A reliable valid assessment tool should be used regularly during diagnostic EUS training to track the acquisition of competence and to support trainee feedback. 9: A period of supervised practice should follow the start of independent activity. Supervision can be delivered either on site if other colleagues are already practicing EUS or by maintaining contacts with the training center and/or other EUS experts. 10: Key performance measures including the annual number of procedures, frequency of obtaining a diagnostic sample during EUS-FNA/FNB, and adverse events should be recorded within an electronic documentation system and evaluated.
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Affiliation(s)
- Abdenor Badaoui
- Department of Gastroenterology and Hepatology, CHU UCL NAMUR, Université catholique de Louvain, Yvoir, Belgium
| | - Sara Teles de Campos
- Department of Gastroenterology, Digestive Unit, Champalimaud Foundation, Lisbon, Portugal
| | - Pietro Fusaroli
- Unit of Gastroenterology, University of Bologna, Hospital of Imola, Imola, Italy
| | - Rodica Gincul
- Department of Gastroenterology, Jean Mermoz Private Hospital, Lyon, France
| | - Michel Kahaleh
- Division of Gastroenterology, Rutgers University, New Brunswick, New Jersey, USA
| | - Jan-Werner Poley
- Department of Gastroenterology and Hepatology, Maastricht UMC+, Maastricht, The Netherlands
| | - Leonardo Sosa Valencia
- IHU Strasbourg - Institute of Image-Guided Surgery - Université de Strasbourg, Strasbourg, France
| | - Laszlo Czako
- Division of Gastroenterology, Department of Medicine, University of Szeged, Szeged, Hungary
| | - Angels Gines
- Endoscopy Unit, Gastroenterology Department, ICMDM, Hospital Clínic, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - Tomas Hucl
- Department of Gastroenterology and Hepatology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Evangelos Kalaitzakis
- Department of Gastroenterology, University Hospital of Heraklion, University of Crete, Heraklion, Greece
| | - Maria Chiara Petrone
- Division of Pancreatobiliary Endoscopy and Endosonography, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Riadh Sadik
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
| | - Lydi van Driel
- Department of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, The Netherlands
| | - Lieven Vandeputte
- Department of Gastroenterology and Hepatology, AZ Sint-Jan Brugge-Oostende AV, Bruges, Belgium
| | - Tony Tham
- Department of Gastroenterology and Hepatology, Ulster Hospital, Dundonald, Northern Ireland
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10
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Miutescu B, Dhir V. Impact and assessment of training models in interventional endoscopic ultrasound. Dig Endosc 2024; 36:59-73. [PMID: 37634116 DOI: 10.1111/den.14667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 08/20/2023] [Indexed: 08/28/2023]
Abstract
Interventional endoscopic ultrasound (IEUS) has gained significant popularity in recent years because of its diagnostic and therapeutic capabilities. The proper training of endoscopists is critical to ensure safe and effective procedures. This review study aims to assess the impact of different training models on the competence of trainees performing IEUS. Eight studies that evaluated simulators for IEUS were identified in the medical literature. Various training models have been used, including the EASIE-R, Mumbai EUS, EUS Magic Box, EndoSim, Thai Association for Gastrointestinal Endoscopy model, and an ex vivo porcine model (HiFi SAM). The trainees underwent traditional didactic lectures, hands-on training using simulators, and direct supervision by experienced endoscopists. The effectiveness of these models has been evaluated based on objective and subjective parameters such as technical proficiency, operative time, diagnostic success, and participant feedback. As expected, the majority of skills were improved after the training sessions concluded, although the risk of bias is high in the absence of external validation. It is difficult to determine the ideal simulator among the existing ones because of the wide variation between them in terms of costs, reusability, design, fidelity of anatomical structures and feedback, and types of procedures performed. There is a need for a standardized approach for the evaluation of IEUS simulators and the ways skills are acquired by trainees, as well as a clearer definition of the key personal attributes necessary for developing a physician into a skilled endoscopist capable of performing basic and advanced therapeutic EUS interventions.
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Affiliation(s)
- Bogdan Miutescu
- Department of Gastroenterology and Hepatology, "Victor Babeş" University of Medicine and Pharmacy, Timisoara, Romania
| | - Vinay Dhir
- Institute of Digestive and Liver Care, SL Raheja Hospital, Mumbai, India
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11
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El Menabawey T, McCrudden R, Shetty D, Hopper AD, Huggett MT, Bekkali N, Carroll NR, Henry E, Johnson GJ, Keane MG, Love M, McKay CJ, Norton S, Oppong K, Penman I, Ramesh J, Ryan B, Siau K, Nayar M. UK and Ireland Joint Advisory Group (JAG) consensus statements for training and certification in diagnostic endoscopic ultrasound (EUS). Gut 2023; 73:118-130. [PMID: 37739777 PMCID: PMC10715553 DOI: 10.1136/gutjnl-2023-329800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 09/02/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND AND AIMS International endoscopy societies vary in their approach for credentialing individuals in endoscopic ultrasound (EUS) to enable independent practice; however, there is no consensus in this or its implementation. In 2019, the Joint Advisory Group on GI Endoscopy (JAG) commissioned a working group to examine the evidence relating to this process for EUS. The aim of this was to develop evidence-based recommendations for EUS training and certification in the UK. METHODS Under the oversight of the JAG quality assurance team, a modified Delphi process was conducted which included major stakeholders from the UK and Ireland. A formal literature review was made, initial questions for study were proposed and recommendations for training and certification in EUS were formulated after a rigorous assessment using the Grading of Recommendation Assessment, Development and Evaluation tool and subjected to electronic voting to identify accepted statements. These were peer reviewed by JAG and relevant stakeholder societies before consensus on the final EUS certification pathway was achieved. RESULTS 39 initial questions were proposed of which 33 were deemed worthy of assessment and finally formed the key recommendations. The statements covered four key domains, such as: definition of competence (13 statements), acquisition of competence (10), assessment of competence (5) and postcertification mentorship (5). Key recommendations include: (1) minimum of 250 hands-on cases before an assessment for competency can be made, (2) attendance at the JAG basic EUS course, (3) completing a minimum of one formative direct observation of procedural skills (DOPS) every 10 cases to allow the learning curve in EUS training to be adequately studied, (4) competent performance in summative DOPS assessments and (5) a period of mentorship over a 12-month period is recommended as minimum to support and mentor new service providers. CONCLUSIONS An evidence-based certification pathway has been commissioned by JAG to support and quality assure EUS training. This will form the basis to improve quality of training and safety standards in EUS in the UK and Ireland.
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Affiliation(s)
- Tareq El Menabawey
- Pancreatobiliary Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK
- Department of Gastroenterology, Homerton University Hospital, London, UK
| | - Raymond McCrudden
- Department of Gastroenterology, University Hospitals Dorset NHS Trust, Bournemouth, UK
| | - Dushyant Shetty
- Department of Radiology, Royal Cornwall Hospitals NHS Trust, Truro, UK
| | - Andrew D Hopper
- Department of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - Noor Bekkali
- Department of Gastroenterology and Hepatology, University of Oxford, Translational Gastroenterology Unit, Oxford, UK
| | - Nicholas R Carroll
- Radiology, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Elaine Henry
- Department of Gastroenterology, NHS Tayside, Dundee, UK
| | - Gavin J Johnson
- Pancreatobiliary Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK
| | - Margaret G Keane
- Gastroenterology and Hepatology, Johns Hopkins, Baltimore, Maryland, USA
| | - Mark Love
- Radiology, Belfast City Hospital, Belfast, UK
| | - Colin J McKay
- West of Scotland Pancreatic Unit, Glasgow Royal Infirmary, Glasgow, UK
| | - Sally Norton
- Upper Gastrointestinal Surgery, Bristol Royal Infirmary, Bristol, UK
| | - Kofi Oppong
- HPB Unit & Department of Gastroenterology, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
- Translational and Clinical Research Institute, University of Newcastle upon Tyne, Newcastle upon Tyne, UK
| | - Ian Penman
- Centre for Liver & Digestive Disorders, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Jayapal Ramesh
- Department of Gastroenterology, Royal Liverpool Hospital NHS Trust, Liverpool, UK
| | - Barbara Ryan
- Department of Gastroenterology, Trinity College Dublin, Dublin, Ireland
| | - Keith Siau
- Gastroenterology, Royal Cornwall Hospitals NHS Trust, Truro, UK
| | - Manu Nayar
- Department of Gastroenterology, Freeman Hospital, Newcastle upon Tyne, UK
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12
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Sirtl S, Vornhülz M, Hofmann FO, Mayerle J, Beyer G. [Pancreatic cancer-screening or surveillance?]. RADIOLOGIE (HEIDELBERG, GERMANY) 2023; 63:908-915. [PMID: 37878016 DOI: 10.1007/s00117-023-01227-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
BACKGROUND Despite continuous improvement of diagnostic and therapeutic procedures, the number of new pancreatic ductal adenocarcinoma (PDAC) cases diagnosed annually almost equals the number of PDAC-related deaths. Prerequisite for curative treatment is a resectable tumor at the time of diagnosis. Individuals with genetic and/or familial risk profiles should therefore be screened and included in structured surveillance programs. OBJECTIVES Description of the status quo and usefulness of current PDAC screening and surveillance concepts. METHODS A selective literature search of current national and international guidelines including underlying literature was performed. RESULTS Nearly half of pancreatic cancer cases are missed by currently available surveillance programs, even in high-risk cohorts. Magnetic resonance imaging and endoscopic ultrasound supplemented by CA19‑9 (± HbA1c) are not accurate enough to ensure robust earlier pancreatic cancer detection. Complementary biomarker panels will take on a crucial diagnostic role in the future.
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Affiliation(s)
- Simon Sirtl
- Medizinische Klinik und Poliklinik II, LMU Klinikum, 81377, München, Deutschland.
| | - Marlies Vornhülz
- Medizinische Klinik und Poliklinik II, LMU Klinikum, 81377, München, Deutschland
| | - Felix O Hofmann
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, LMU Klinikum, München, Deutschland
| | - Julia Mayerle
- Medizinische Klinik und Poliklinik II, LMU Klinikum, 81377, München, Deutschland.
| | - Georg Beyer
- Medizinische Klinik und Poliklinik II, LMU Klinikum, 81377, München, Deutschland
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13
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Aloysius M, Goyal H, Nikumbh T, Shah NJ, Hammoud GM, Mutha P, Joseph-Talreja M, John S, Aswath G, Wadhwa V, Thosani N. Endoscopic retrograde cholangiopancreatography-related early perforations: A study of effects of procedure duration, complexity, and endoscopist experience. World J Gastrointest Endosc 2023; 15:641-648. [DOI: 10.4253/wjge.v15.i11.641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 08/06/2023] [Accepted: 09/27/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Perforations (Perf) during endoscopic retrograde cholangiopancreatography (ERCP) are rare (< 1%) but potentially fatal events (up to 20% mortality). Given its rarity, most data is through case series studies from centers or analysis of large databases. Although a meta-analysis has shown fewer adverse events as a composite (bleeding, pancreatitis, Perf) during ERCP performed at high-volume centers, there is very little real-world data on endoscopist and center procedural volumes, ERCP duration and complexity on the occurrence of Perf.
AIM To study the profile of Perf related to ERCP by center and endoscopist procedure volume, ERCP time, and complexity from a national endoscopic repository.
METHODS Patients from clinical outcomes research initiative-national endoscopic database (2000-2012) who underwent ERCP were stratified based on the endoscopist and center volume (quartiles), and total procedure duration and complexity grade of the ERCP based on procedure details. The effects of these variables on the Perf that occurred were studied. Continuous variables were compared between Perf and no perforations (NoPerf) using the Mann-Whitney U test as the data demonstrated significant skewness and kurtosis.
RESULTS A total of 14153 ERCPs were performed by 258 endoscopists, with 20 reported Perf (0.14%) among 16 endoscopists. Mean patient age in years 61.6 ± 14.8 vs 58.1 ± 18.8 (Perf vs. NoPerf, P = NS). The cannulation rate was 100% and 91.5% for Perf and NoPerf groups, respectively. 13/20 (65%) of endoscopists were high-volume performers in the 4th quartile, and 11/20 (55%) of Perf occurred in centers with the highest volumes (4th quartile). Total procedure duration in minutes was 60.1 ± 29.9 vs 40.33 ± 23.5 (Perf vs NoPerf, P < 0.001). Fluoroscopy duration in minutes was 3.3 ± 2.3 vs 3.3 ± 2.6 (Perf vs NoPerf P = NS). 50% of the procedures were complex and greater than grade 1 difficulty. 3/20 (15%) patients had prior biliary surgery. 13/20 (65%) had sphincterotomies performed with stent insertion. Peritonitis occurred in only 1/20 (0.5%).
CONCLUSION Overall adverse events as a composite during ERCP are known to occur at a lower rate with higher volume endoscopists and centers. However, Perf studied from the national database show prolonged and more complex procedures performed by high-volume endoscopists at high-volume centers contribute to Perf.
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Affiliation(s)
- Mark Aloysius
- Division of Gastroenterology, Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, NY 13210, United States
| | - Hemant Goyal
- Department of Surgery, The University of Texas Health Science Center, Houston, TX 77030, United States
| | - Tejas Nikumbh
- Department of Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, PA 18510, United States
| | - Niraj James Shah
- Department of Medicine, Division of Digestive Diseases, The University of Missouri at Columbia, Columbia, MO 65211, United States
| | - Ghassan M Hammoud
- Department of Medicine, Division of Digestive Diseases, The University of Missouri at Columbia, Columbia, MO 65211, United States
| | - Pritesh Mutha
- Department of Surgery, The University of Texas Health Science Center, Houston, TX 77030, United States
| | - Mairin Joseph-Talreja
- Department of Surgery, The University of Texas Health Science Center, Houston, TX 77030, United States
| | - Savio John
- Division of Gastroenterology, Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, NY 13210, United States
| | - Ganesh Aswath
- Division of Gastroenterology, Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, NY 13210, United States
| | - Vaibhav Wadhwa
- Department of Surgery, The University of Texas Health Science Center, Houston, TX 77030, United States
| | - Nirav Thosani
- Department of Surgery, The University of Texas Health Science Center, Houston, TX 77030, United States
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14
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Teles de Campos S, Boskoski I, Voiosu T, Arvanitakis M, Costamagna G, Devière J. Face and content validity of a biological papilla designed for the Boškoski-Costamagna ERCP simulator. Gastrointest Endosc 2023; 98:822-829.e1. [PMID: 37390863 DOI: 10.1016/j.gie.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/09/2023] [Accepted: 06/14/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND AND AIMS A biological papilla made of chicken heart tissue, incorporated into the Boškoski-Costamagna ERCP Trainer simulator, was recently designed to allow training in sphincterotomy. This study aimed to evaluate the face and content validity of this tool. METHOD Participants from 2 groups (nonexperienced and experienced [<600 or >600 lifetime ERCPs, respectively]) were invited to perform standardized assignments on the model: sphincterotomy and precut for both groups and papillectomy for the experienced group. Following these assignments, all participants filled out a questionnaire to rate their appreciation of the realism of the model, and experienced endoscopists were also asked to evaluate its didactic value using a 5-point Likert scale. RESULTS A total of 19 participants were included (nonexperienced, n = 10; experienced, n = 9). Parameters regarding the realism of the tool in terms of general appearance, sphincterotomy, precut, and papillectomy were overall considered realistic (4 of 5), with good agreement rates in terms of overall realism between groups. Experienced operators reported the highest realism for "positioning the scope and needle-knife in the field of view" and "during precut," "cutting in small increments during precut," and "controlling the scope during papillectomy," and they highly agreed that this papilla should be included for training novice and intermediate trainees in sphincterotomy, precut, and papillectomy. CONCLUSIONS Our results show good face validity and excellent content validity of this biological papilla combined with the Boškoski-Costamagna ERCP Trainer. This new tool provides a useful, inexpensive, versatile, and easy tool for training regarding sphincterotomy, precut, and papillectomy. Future studies should explore whether including this model in real-life training improves the learning curve of endoscopy trainees.
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Affiliation(s)
- Sara Teles de Campos
- Gastroenterology Department, Digestive Unit, Champalimaud Foundation, Lisbon, Portugal; Université Libre de Bruxelles, Brussels, Belgium.
| | - Ivo Boskoski
- Gastroenterology and Digestive Endoscopy, Fondazione Policlinico Gemelli, Rome, Italy
| | - Theodor Voiosu
- Gastroenterology Department, Colentina Clinical Hospital, Carol Davila Faculty of Medicine, Bucharest, Romania
| | - Marianna Arvanitakis
- Université Libre de Bruxelles, Brussels, Belgium; Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasmus University Hospital, Brussels, Belgium
| | - Guido Costamagna
- Gastroenterology and Digestive Endoscopy, Fondazione Policlinico Gemelli, Rome, Italy
| | - Jacques Devière
- Gastroenterology Department, Digestive Unit, Champalimaud Foundation, Lisbon, Portugal; Université Libre de Bruxelles, Brussels, Belgium; Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasmus University Hospital, Brussels, Belgium
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15
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Magahis PT, Salgado S, Westerveld D, Dawod E, Carr-Locke DL, Sampath K, Sharaiha RZ, Mahadev S. Preferred techniques for endoscopic ultrasound-guided gastroenterostomy: a survey of expert endosonographers. Endosc Int Open 2023; 11:E1035-E1045. [PMID: 37954107 PMCID: PMC10635781 DOI: 10.1055/a-2185-6426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 09/15/2023] [Indexed: 11/14/2023] Open
Abstract
Background and study aims Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is an emerging procedure that lacks technical standardization with limited adoption beyond expert centers. We surveyed high-volume endosonographers about the technical aspects of EUS-GE to describe how the procedure is currently performed at expert centers and identify targets for standardization. Methods Invitations to complete an electronic survey were distributed to 21 expert EUS practitioners at 19 U.S. centers. Respondents were surveyed about technical aspects of EUS-GE, indications, efficacy, safety, and attitudes toward the procedure. Results All 21 (100%) invited expert endoscopists completed the survey. Nine (42.9%) reported performing >10 EUS-GEs in the last 12 months. About half (47.6%, 10/21) puncture the target loop prior to lumen-apposing metal stent (LAMS) introduction, most often to confirm the loop is jejunum. No respondents reported guidewire placement prior to LAMS introduction. Most (71.4%, 15/21) do not use a guidewire at any time, while 28.6% (6/21) reported wire placement after distal flange deployment to secure the tract during apposition. Eight (38.1%, 8/21) reported at least one major adverse event, most commonly intraperitoneal LAMS deployment (87.5%, 7/8). Factors most often reported as advantageous for EUS-GE over enteral stenting included lack of papilla interference (33.3%, 7/21) and decreased occlusion risk (23.8%, 5/21). Conclusions Significant variation in performance technique for EUS-GE exists among expert US endoscopists, which may hinder widespread adoption and contribute to inconsistencies in reported patient outcomes. The granularity provided by these survey results may identify areas to focus standardization efforts and guide future studies on developing an ideal EUS-GE protocol.
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Affiliation(s)
| | - Sanjay Salgado
- Division of Gastroenterology and Hepatology, NewYork-Presbyterian Weill Cornell Medical Center, New York, United States
| | - Donevan Westerveld
- Division of Gastroenterology and Hepatology, NewYork-Presbyterian Weill Cornell Medical Center, New York, United States
| | - Enad Dawod
- Division of Gastroenterology and Hepatology, NewYork-Presbyterian Weill Cornell Medical Center, New York, United States
| | - David L. Carr-Locke
- Division of Gastroenterology and Hepatology, NewYork-Presbyterian Weill Cornell Medical Center, New York, United States
| | - Kartik Sampath
- Division of Gastroenterology and Hepatology, NewYork-Presbyterian Weill Cornell Medical Center, New York, United States
| | - Reem Z. Sharaiha
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, United States
| | - Srihari Mahadev
- Division of Gastroenterology and Hepatology, NewYork-Presbyterian Weill Cornell Medical Center, New York, United States
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16
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Gimenez ME, Uribe Rivera AK, Montanelli J, Swanström LL, Mutter D, Seeliger B. Cholangioscopy under direct visualization: skill progress during a dedicated Image-Guided Surgery Course. Surg Endosc 2023; 37:8116-8122. [PMID: 37658199 DOI: 10.1007/s00464-023-10357-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 07/30/2023] [Indexed: 09/03/2023]
Abstract
AIMS Training programs are essential to introduce new methods for bile duct clearance. Visual examination via cholangioscopy is ideal to diagnose and treat biliary tract diseases such as cancer and choledocholithiasis. However, surgeons rarely use cholangioscopes. Specific training is required to master laparoscopic and percutaneous cholangioscopy. This study aims to assess skill acquisition and retention during cholangioscopy training in the Image-Guided Therapies Masterclass. METHODS This prospective study enrolled 17 physicians undergoing training in interventional treatments of biliary diseases. A novel disposable cholangioscope and access kit were used with a biliary tract model including two simulated common bile duct (CBD) stones. The curriculum required visualization of all critical structures before removal of one stone with a Dormia basket. After informed consent, demographic data and time to exercise completion were recorded on each of two subsequent training days. Task-specific questions were measured at the completion of training using a Likert scale (strongly disagree to strongly agree, 1-5 points). RESULTS All participants successfully completed the task (6F/11 M, age 36 ± 5 years; 13 surgeons, 4 interventional radiologists; median experience with percutaneous procedures 2 years, range 0-20). Significant improvement in mean task completion time was observed (day 1: 172 ± 59 s, day 2: 89 ± 45 s; P < 0.0001). All task-specific questions were answered with a median rating of 5/5: "The platform facilitates cholangioscopy" and "This training method accelerates gain in proficiency and is useful for residents/fellows" (IQR 5-5), "This platform is useful to measure the proficiency level" and "There is an application for simulation in percutaneous surgery training" (IQR 4.5-5), "The platform is user-friendly" and "The model quality recreates realistic scenarios" (IQR 4-5). CONCLUSION Cholangioscopic bile duct exploration and stone retrieval were achieved by all participants using a dedicated training program and physical simulator. Significant skill progress was observed during 2 days of dedicated training.
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Affiliation(s)
- M E Gimenez
- Institute of Image-Guided Surgery, IHU-Strasbourg, 1, Place de l'Hôpital, 67000, Strasbourg, France.
- DAICIM Foundation (Training, Research and Clinical Activity in Minimally Invasive Surgery), Buenos Aires, Argentina.
- Research Institute Against Digestive Cancer, IRCAD, Strasbourg, France.
| | - A K Uribe Rivera
- Institute of Image-Guided Surgery, IHU-Strasbourg, 1, Place de l'Hôpital, 67000, Strasbourg, France
| | - J Montanelli
- Institute of Image-Guided Surgery, IHU-Strasbourg, 1, Place de l'Hôpital, 67000, Strasbourg, France
| | - L L Swanström
- Institute of Image-Guided Surgery, IHU-Strasbourg, 1, Place de l'Hôpital, 67000, Strasbourg, France
| | - D Mutter
- Institute of Image-Guided Surgery, IHU-Strasbourg, 1, Place de l'Hôpital, 67000, Strasbourg, France
- Department of Digestive and Endocrine Surgery, University Hospitals of Strasbourg, Strasbourg, France
- Research Institute Against Digestive Cancer, IRCAD, Strasbourg, France
| | - B Seeliger
- Institute of Image-Guided Surgery, IHU-Strasbourg, 1, Place de l'Hôpital, 67000, Strasbourg, France
- Department of Digestive and Endocrine Surgery, University Hospitals of Strasbourg, Strasbourg, France
- Research Institute Against Digestive Cancer, IRCAD, Strasbourg, France
- ICube, UMR 7357 CNRS, University of Strasbourg, Strasbourg, France
- Institute for Viral and Liver Diseases, Inserm U1110, Strasbourg, France
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17
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Hamada T, Michihata N, Saito T, Iwashita T, Shiomi H, Takenaka M, Matsui H, Fushimi K, Isayama H, Yasuda I, Yasunaga H, Nakai Y. Inverse association of hospital volume with in-hospital mortality rate of patients receiving EUS-guided interventions for pancreatic fluid collections. Gastrointest Endosc 2023; 98:597-606.e2. [PMID: 37150410 DOI: 10.1016/j.gie.2023.04.2091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/31/2023] [Accepted: 04/28/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND AND AIMS EUS-guided interventions currently serve as first-line treatment for symptomatic pancreatic fluid collections (PFCs) but require high-level expertise and multidisciplinary care. Hospital caseload has not been fully examined in relation to clinical outcomes of patients with endoscopically managed PFCs. METHODS Using the Diagnosis Procedure Combination database (a Japanese nationwide inpatient database), we identified 4053 patients receiving EUS-guided treatment of PFCs at 486 hospitals between 2010 and 2020 and examined an association of hospital volume (average annual number of cases at a hospital) with in-hospital mortality. Associations with bleeding, length of stay, and total costs were examined as secondary analyses. Multivariable logistic regression analysis was conducted with adjustment for potential confounders. RESULTS The hospital volume was inversely associated with the risk of in-hospital mortality (Ptrend < .001). The adjusted odds ratio for in-hospital mortality comparing the extreme quintiles of hospital volume was .17 (95% confidence interval, .09-.33). A restricted cubic spline analysis yielded no statistically significant evidence on the nonlinear relationship (Pnonlinearity = .19). The types of stents (plastic vs lumen-apposing metal stent) seemed to have no effect modification on the volume-mortality relationship (Pinteraction = .58). Higher hospital volume was also associated with lower risk of bleeding, shorter length of stay, and lower medical costs of inpatient care. CONCLUSIONS Higher hospital volume was associated with a lower risk of in-hospital mortality of patients receiving EUS-guided treatment of PFCs. A further investigation is warranted to justify the volume-based selective referral of the patients.
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Affiliation(s)
- Tsuyoshi Hamada
- Department of Gastroenterology, Graduate School of Medicine; Department of Hepato-Biliary-Pancreatic Medicine, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.
| | | | - Tomotaka Saito
- Department of Gastroenterology, Graduate School of Medicine
| | - Takuji Iwashita
- First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan
| | - Hideyuki Shiomi
- Division of Gastroenterology and Hepatobiliary and Pancreatic Diseases, Department of Internal Medicine, Hyogo Medical University, Hyogo, Japan
| | - Mamoru Takenaka
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroyuki Isayama
- Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Ichiro Yasuda
- Third Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Yousuke Nakai
- Department of Gastroenterology, Graduate School of Medicine; Department of Endoscopy and Endoscopic Surgery, The University of Tokyo Hospital, Tokyo, Japan
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Voiosu TA, Benguș A, Bronswijk M, Lyutakov I, Klarin I, Voiosu B, Bălănescu P, Diaconu C, Busuioc B, Boskoski I, Voiosu AM, Mateescu RB, Wani S. A simple clinical score to stratify the risk of procedure-related adverse events in ERCP procedures with trainee involvement. Endoscopy 2023; 55:804-811. [PMID: 36828031 DOI: 10.1055/a-2042-6288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
BACKGROUND : Optimal training strategies in endoscopic retrograde cholangiopancreatography (ERCP) remain controversial despite the shift toward competence-based training models, with limited data available on patient safety during training. We aimed to assess whether pre-procedural clinical predictors could identify patients at low risk of developing procedure-related adverse-events (AEs) in a training environment. METHODS : We performed a prospective, multicenter, cohort study in five training centers. A data collection system documenting indication, clinical data, trainee performance (assessed using a validated competence assessment tool), technical outcomes, and AEs over a 30-day follow-up was utilized. We developed a clinical risk score (Trainee Involvement in ERCP Risk Score [TIERS]) for patients undergoing ERCP and compared the rate of AEs in a training environment between low-risk and high-risk groups. The association between trainee performance and AE rate was also evaluated. RESULTS : 1283 ERCPs (409 [31.9 %, 95 %CI 29.3 %-34.4 %] with trainee involvement) performed by 11 trainers and 10 trainees were analyzed. AEs were more frequent in the high-risk compared with the low-risk group: 26.7 % (95 %CI 20.5 %-34.7 %) vs. 17.1 % (95 %CI 12.8 %-22.2 %). TIERS demonstrated a high negative predictive value for AEs (82.9 %, 95 %CI 79.4 %-85.8 %) and was the only predictor of AEs on multivariable analysis (odds ratio 1.38, 95 %CI 1.09-1.75). Suboptimal trainee performance was associated with an increase in AE rates. CONCLUSION : Simple, clinical-based predictive tools could improve ERCP training by selecting the most appropriate cases for hands-on training, with the aim of increasing patient safety.
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Affiliation(s)
- Theodor A Voiosu
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania
- Department of Internal Medicine, Carol Davila University of Medicine, Bucharest, Romania
| | - Andreea Benguș
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania
| | - Michiel Bronswijk
- Department of Gastroenterology and Hepatology, Imelda Hospital, Bonheiden, Belgium
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
- Imelda GI Research Center, Bonheiden, Belgium
| | - Ivan Lyutakov
- Department of Gastroenterology, University Hospital "Tsaritsa Yoanna - ISUL", Sofia, Bulgaria
- Department of Gastroenterology, Medical University Sofia, Sofia, Bulgaria
| | - Ivo Klarin
- Department of Health Studies, University of Zadar, Zadar, Croatia
- Gastroenterology Department, General Hospital Zadar, Zadar, Croatia
| | - Bianca Voiosu
- Gastroenterology Department, Cantacuzino Hospital, Bucharest, Romania
| | - Paul Bălănescu
- Internal Medicine Department, Carol Davila School of Medicine, Bucharest, Romania
- Clinical Immunology Department, Colentina Clinical Hospital, Bucharest, Romania
| | - Claudia Diaconu
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania
| | - Bogdan Busuioc
- Gastroenterology Department, Cantacuzino Hospital, Bucharest, Romania
| | - Ivo Boskoski
- Gastroenterology, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
- Centre for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrei M Voiosu
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania
- Department of Internal Medicine, Carol Davila University of Medicine, Bucharest, Romania
| | - Radu B Mateescu
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania
- Department of Internal Medicine, Carol Davila University of Medicine, Bucharest, Romania
| | - Sachin Wani
- University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
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Teles de Campos S, Papaefthymiou A, Florou T, Facciorusso A, Arvanitakis M, Devière J, Gkolfakis P. Impact of center and endoscopist ERCP volume on ERCP outcomes: a systematic review and meta-analysis. Gastrointest Endosc 2023; 98:306-315.e14. [PMID: 37201726 DOI: 10.1016/j.gie.2023.05.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/08/2023] [Accepted: 05/06/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND AND AIMS Endoscopist experience and center volume might be associated with ERCP outcomes, as in other fields of endoscopy and in surgery. An effort to assess this relationship is important to improve practice. This systematic review and meta-analysis aimed to evaluate these comparative data and to assess the impact of endoscopist and center volume on ERCP procedure outcomes. METHODS We performed a literature search in PubMed, Web of Science, and Scopus through March 2022. Volume classification included high- and low-volume (HV and LV) endoscopists and centers. The primary outcome was the impact of endoscopist and center volume on ERCP success. Secondary outcomes were the overall adverse event (AE) rate and the specific AE rate. The quality of the studies was assessed using the Newcastle-Ottawa scale. Data synthesis was obtained by direct meta-analyses using a random-effects model; results are presented as odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS Of 6833 relevant publications, 31 studies met the inclusion criteria. Procedure success was higher among HV endoscopists (OR, 1.81; 95% CI, 1.59-2.06; I2 = 57%) and in HV centers (OR, 1.77; 95% CI, 1.22-2.57; I2 = 67%). The overall AE rate was lower for procedures performed by HV endoscopists (OR, .71; 95% CI, .61-.82; I2 = 38%) and in HV centers (OR, .70; 95% CI, .51-.97; I2 = 92%). Bleeding was less frequent in procedures performed by HV endoscopists (OR, .67; 95% CI, .48-.95; I2 = 37%) but did not differ based on center volume (OR, .68; 95% CI, .24-1.90; I2 = 89%). No statistical differences were detected concerning pancreatitis, cholangitis, and perforation rates. CONCLUSIONS HV endoscopists and centers provide higher ERCP success rates with fewer overall AEs, especially bleeding, compared with respective LV comparators.
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Affiliation(s)
- Sara Teles de Campos
- Gastroenterology Department, Digestive Unit, Champalimaud Foundation, Lisbon, Portugal; Université Libre Bruxelles, Brussels, Belgium.
| | - Apostolis Papaefthymiou
- Pancreaticobiliary Medicine Unit, University College London Hospitals (UCLH) NHS Foundation Trust, London, United Kingdom; Department of Gastroenterology, University Hospital of Larissa, Thessaly, Greece
| | - Theodosia Florou
- Department of Gastroenterology, University Hospital of Larissa, Thessaly, Greece
| | - Antonio Facciorusso
- Section of Gastroenterology, Department of Medical Sciences, University of Foggia, Foggia, Italy
| | - Marianna Arvanitakis
- Université Libre Bruxelles, Brussels, Belgium; Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Brussels, Belgium
| | - Jacques Devière
- Gastroenterology Department, Digestive Unit, Champalimaud Foundation, Lisbon, Portugal; Université Libre Bruxelles, Brussels, Belgium; Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Brussels, Belgium
| | - Paraskevas Gkolfakis
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Brussels, Belgium; Konstantopoulio-Patision General Hospital of Athens, Athens, Greece
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20
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Khan R, Homsi H, Gimpaya N, Lisondra J, Sabrie N, Gholami R, Bansal R, Scaffidi MA, Lightfoot D, James PD, Siau K, Forbes N, Wani S, Keswani RN, Walsh CM, Grover SC. Validity evidence for observational ERCP competency assessment tools: a systematic review. Endoscopy 2023; 55:847-856. [PMID: 36822219 DOI: 10.1055/a-2041-7546] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
BACKGROUND : Assessment of competence in endoscopic retrograde cholangiopancreatography (ERCP) is critical for supporting learning and documenting attainment of skill. Validity evidence supporting ERCP observational assessment tools has not been systematically evaluated. METHODS : We conducted a systematic search using electronic databases and hand-searching from inception until August 2021 for studies evaluating observational assessment tools of ERCP performance. We used a unified validity framework to characterize validity evidence from five sources: content, response process, internal structure, relations to other variables, and consequences. Each domain was assigned a score of 0-3 (maximum score 15). We assessed educational utility and methodological quality using the Accreditation Council for Graduate Medical Education framework and the Medical Education Research Quality Instrument, respectively. RESULTS : From 2769 records, we included 17 studies evaluating 7 assessment tools. Five tools were studied for clinical ERCP, one for simulated ERCP, and one for simulated and clinical ERCP. Validity evidence scores ranged from 2 to 12. The Bethesda ERCP Skills Assessment Tool (BESAT), ERCP Direct Observation of Procedural Skills Tool (ERCP DOPS), and The Endoscopic Ultrasound (EUS) and ERCP Skills Assessment Tool (TEESAT) had the strongest validity evidence, with scores of 10, 12, and 11, respectively. Regarding educational utility, most tools were easy to use and interpret, and required minimal additional resources. Overall methodological quality (maximum score 13.5) was strong, with scores ranging from 10 to 12.5. CONCLUSIONS : The BESAT, ERCP DOPS, and TEESAT had strong validity evidence compared with other assessments. Integrating tools into training may help drive learners' development and support competency decision making.
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Affiliation(s)
- Rishad Khan
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Hoomam Homsi
- Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Nikko Gimpaya
- Division of Gastroenterology, St. Michael's Hospital, Toronto, Canada
| | - James Lisondra
- Division of Gastroenterology, St. Michael's Hospital, Toronto, Canada
| | | | - Reza Gholami
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Toronto, Toronto, Canada
- Division of Gastroenterology, St. Michael's Hospital, Toronto, Canada
| | - Rishi Bansal
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | | | - David Lightfoot
- Health Science Library, Unity Health Toronto, St. Michael's Hospital, Toronto, Canada
| | - Paul D James
- Division of Gastroenterology, University Health Network, Toronto, Canada
| | - Keith Siau
- Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, United Kingdom
- Immunology and Immunotherapy, University of Birmingham College of Medical and Dental Sciences, Birmingham, United Kingdom
| | - Nauzer Forbes
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Sachin Wani
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Rajesh N Keswani
- Division of Gastroenterology, Department of Medicine, Northwestern University, Chicago, Illinois, United States
| | - Catharine M Walsh
- The Wilson Centre, University of Toronto, Toronto, Canada
- SickKids Research and Learning Institute, The Hospital for Sick Children, Toronto, Canada
- Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Canada
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Samir C Grover
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Toronto, Toronto, Canada
- Division of Gastroenterology, St. Michael's Hospital, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- Li Ka Shing Knowledge Institute, Toronto, Canada
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21
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Rivas A, Pherwani S, Mohamed R, Smith ZL, Elmunzer BJ, Forbes N. ERCP-related adverse events: incidence, mechanisms, risk factors, prevention, and management. Expert Rev Gastroenterol Hepatol 2023; 17:1101-1116. [PMID: 37899490 DOI: 10.1080/17474124.2023.2277776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 10/27/2023] [Indexed: 10/31/2023]
Abstract
INTRODUCTION Endoscopic retrograde cholangiopancreatography (ERCP) is a commonly performed procedure for pancreaticobiliary disease. While ERCP is highly effective, it is also associated with the highest adverse event (AE) rates of all commonly performed endoscopic procedures. Thus, it is critical that endoscopists and caregivers of patients undergoing ERCP have clear understandings of ERCP-related AEs. AREAS COVERED This narrative review provides a comprehensive overview of the available evidence on ERCP-related AEs. For the purposes of this review, we subdivide the presentation of each ERCP-related AE according to the following clinically relevant domains: definitions and incidence, proposed mechanisms, risk factors, prevention, and recognition and management. The evidence informing this review was derived in part from a search of the electronic databases PubMed, Embase, and Cochrane, performed on 1 May 20231 May 2023. EXPERT OPINION Knowledge of ERCP-related AEs is critical not only given potential improvements in peri-procedural quality and related care that can ensue but also given the importance of reviewing these considerations with patients during informed consent. The ERCP community and researchers should aim to apply standardized definitions of AEs. Evidence-based knowledge of ERCP risk factors should inform patient care decisions during training and beyond.
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Affiliation(s)
- Angelica Rivas
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Simran Pherwani
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Rachid Mohamed
- Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
| | - Zachary L Smith
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - B Joseph Elmunzer
- Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, SC, USA
| | - Nauzer Forbes
- Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Lekkerkerker SJ, Voermans RP. EUS and ERCP training in Europe: Time for simulation, optimization, and standardization. United European Gastroenterol J 2023; 11:407-409. [PMID: 37151136 PMCID: PMC10256995 DOI: 10.1002/ueg2.12399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/09/2023] Open
Affiliation(s)
- Selma J. Lekkerkerker
- Department of Gastroenterology and HepatologyAmsterdam University Medical CenterAmsterdamthe Netherlands
| | - Rogier P. Voermans
- Department of Gastroenterology and HepatologyAmsterdam University Medical CenterAmsterdamthe Netherlands
- Amsterdam Gastroenterology Endocrinology MetabolismAmsterdamthe Netherlands
- Cancer Center AmsterdamAmsterdamthe Netherlands
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23
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Chiba M, Kato M, Kinoshita Y, Akasu T, Matsui H, Shimamoto N, Tomita Y, Abe T, Kanazawa K, Tsukinaga S, Nakano M, Torisu Y, Toyoizumi H, Suka M, Sumiyama K. Analysis of the variation in learning curves for achieving competency in convex EUS training: a prospective cohort study using a standardized assessment tool. Gastrointest Endosc 2023; 97:722-731.e7. [PMID: 36343675 DOI: 10.1016/j.gie.2022.10.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 10/29/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND AIMS The need for mastering standard imaging techniques for convex EUS in the biliopancreatic regions has been increasing; however, large variations in the aptitude for achieving EUS competency hinder expert development. Therefore, we investigated the factors influencing the achievement of expert competency in EUS using a new assessment tool for multiple imaging items. METHODS Between January 2018 and February 2022, 3277 consecutive EUS procedures conducted by 5 beginners (EUS procedures <250), 7 intermediate trainees (250-749), and 2 experts (≥750) were prospectively evaluated. Immediately after each EUS procedure, the success or failure of imaging for each item was recorded using a newly developed EUS assessment tool that requires 17 items to be photographed. After correcting for missing values using multiple imputation, learning curves of EUS scores were created, and a competency was set based on expert scores. Finally, a comparative analysis between high and low performers was performed to extract factors influencing EUS scores. RESULTS Although 3 of 7 intermediates (43%; mean, 317 cases) achieved competency, none of the beginners achieved competency. During a comparative analysis, although no significant difference in the number of EUS procedures performed was observed between the high and low performers, the former had significantly higher scores in the written test (theoretical knowledge). CONCLUSIONS Our results showed that theoretical knowledge, rather than the number of EUS cases, may be a possible influencing factor for distinguishing high and low performers after treating 250 cases. (Clinical trial registration number: UMIN 000043271.).
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Affiliation(s)
- Masafumi Chiba
- Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
| | - Masayuki Kato
- Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
| | - Yuji Kinoshita
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Takafumi Akasu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiroaki Matsui
- Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
| | - Nana Shimamoto
- Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
| | - Youichi Tomita
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Takahiro Abe
- Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
| | - Keisuke Kanazawa
- Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
| | - Shintaro Tsukinaga
- Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
| | - Masanori Nakano
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Yuichi Torisu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Hirobumi Toyoizumi
- Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
| | - Machi Suka
- Department of Public Health and Environmental Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Kazuki Sumiyama
- Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
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24
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Grover AS, Gugig R, Barakat MT. Endoscopy and Pediatric Pancreatitis. Gastrointest Endosc Clin N Am 2023; 33:363-378. [PMID: 36948751 DOI: 10.1016/j.giec.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
Children and adolescents are increasingly impacted by pancreatic disease. Interventional endoscopic procedures, including endoscopic retrograde cholangiopancreatography) and endoscopic ultrasonography, are integral to the diagnosis and management of many pancreatic diseases in the adult population. In the past decade, pediatric interventional endoscopic procedures have become more widely available, with invasive surgical procedures now being replaced by safer and less disruptive endoscopic interventions.
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Affiliation(s)
- Amit S Grover
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA 02115, USA
| | - Roberto Gugig
- Division of Pediatric Gastroenterology, Lucille Packard Children's Hospital at Stanford University Medical Center, Stanford, CA 94305, USA
| | - Monique T Barakat
- Division of Pediatric Gastroenterology, Lucille Packard Children's Hospital at Stanford University Medical Center, Stanford, CA 94305, USA; Division of Gastroenterology, Stanford University Medical Center, Stanford, CA 94305, USA.
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25
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Zepeda-Gómez S, Dávila-Cervantes A, Montaño-Loza AJ, Yang D, Baumgart DC, Kroeker K, Halloran BP. A novel smartphone application for the tracking of procedural numbers and trainee experience in gastrointestinal endoscopy. BMC Med Inform Decis Mak 2023; 23:52. [PMID: 37004058 PMCID: PMC10064511 DOI: 10.1186/s12911-023-02145-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 03/15/2023] [Indexed: 04/03/2023] Open
Abstract
OBJECTIVES The tracking and documentation of procedures in gastrointestinal endoscopy including therapeutic interventions is an essential but challenging process. The University of Alberta has developed a smartphone app to help facilitate this task. This study evaluated the functionality, usefulness, and user satisfaction of this app. METHODS Four Gastroenterology (GI) residents and two therapeutic endoscopy fellows participated in the study. The trainees submitted all their data into the app from the procedures in which they participated hands-on for one year, data was collected and analyzed on the app and the website associated with it. RESULTS Trainees were able to register the procedures immediately after each procedure without difficulty, this data was available to be reviewed at anytime in the app and associated website. Furthermore, the data collected was able to be transformed into tables and graphs on the app website. The total number of procedures and therapeutic interventions performed were easily accessed in the app and website at anytime. The app facilitated the calculation of the cecal intubation rate in colonoscopy and the cannulation rate in ERCP for the therapeutic endoscopy trainee. Trainees reported excellent experience with the app capabilities. CONCLUSIONS A novel smartphone app was useful in collecting meaningful data submitted by gastrointestinal endoscopy trainees, furthermore, through an associated website, it was capable to create graphs and tables to show and facilitate the calculation of meaningful data such as key performance indicators.
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Affiliation(s)
- Sergio Zepeda-Gómez
- Division of Gastroenterology, University of Alberta, Zeidler Ledcor Centre, Edmonton, Canada.
| | - Andrea Dávila-Cervantes
- Division of Gastroenterology, University of Alberta, Zeidler Ledcor Centre, Edmonton, Canada
| | - Aldo J Montaño-Loza
- Division of Gastroenterology, University of Alberta, Zeidler Ledcor Centre, Edmonton, Canada
| | - David Yang
- Division of Gastroenterology, University of Alberta, Zeidler Ledcor Centre, Edmonton, Canada
| | - Daniel C Baumgart
- Division of Gastroenterology, University of Alberta, Zeidler Ledcor Centre, Edmonton, Canada
| | - Karen Kroeker
- Division of Gastroenterology, University of Alberta, Zeidler Ledcor Centre, Edmonton, Canada
| | - Brendan P Halloran
- Division of Gastroenterology, University of Alberta, Zeidler Ledcor Centre, Edmonton, Canada
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Razpotnik M, Bota S, Kutilek M, Essler G, Urak C, Prosenz J, Weber-Eibel J, Maieron A, Peck-Radosavljevic M. Factors Affecting the Learning Curve in the Endoscopic Ultrasound-Guided Sampling of Solid Pancreatic Lesions: A Prospective Study. Gut Liver 2023; 17:308-317. [PMID: 36424720 PMCID: PMC10018312 DOI: 10.5009/gnl210560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/01/2022] [Accepted: 03/15/2022] [Indexed: 11/27/2022] Open
Abstract
Background/Aims Endosonography is associated with a long learning curve. We aimed to assess variables that may influence the diagnostic outcomes in endoscopic ultrasound-guided fine-needle aspiration/biopsy (EUS-FNA/B) of solid pancreatic tumors regarding the level of endoscopists' experience. Methods Consecutive patients undergoing EUS-guided puncture of solid pancreatic tumors (eight endosonographers, including six trainees) were prospectively enrolled. An experienced endosonographer was defined as having performed at least 250 EUS examinations, including 75 FNA/Bs. The final diagnosis was determined by cytopathology, histopathology, or clinical follow-up. Results In total, 283 EUS-FNA/Bs of solid pancreatic tumors (75.6% malignant) in 239 patients (median age 69 years, 57.6% males) were enrolled. Trainees performed 149/283 (52.7%) of the interventions. Accuracy and sensitivity for detecting malignancy were significantly higher in the expert group than in the trainee group (85.8% vs 73.2%, p=0.01 and 82.5% vs 68.4%, p=0.02). Solid lesions evaluated by an expert using FNB needles showed the best odds for a correct diagnosis (odds ratio, 3.07; 95% confidence interval, 1.15 to 8.23; p=0.02). More experienced endoscopists achieved better accuracy in sampling via the transduodenal approach (86.7% vs 68.5%, p<0.001), in the sampling of malignant lesions (82.5 vs 68.4, p=0.02), and in the sampling of lesions located in the pancreatic head (86.1 vs 69.1, p=0.02). In cases involving these factors, we observed a moderate improvement in the diagnostic accuracy after 40 attempts. Conclusions Transduodenal approach, pancreatic head lesions, and malignancy were recognized as the most important clinical factors affecting the learning curve in EUS-FNA/B of solid pancreatic lesions.
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Affiliation(s)
- Marcel Razpotnik
- Departement of Internal Medicine and Gastroenterology (IMuG), Hepatology, Endocrinology, Rheumatology and Nephrology and Emergency Medicine (ZAE) with Centralized Endoscopy Service, Klinikum Klagenfurt am Wörthersee, Klagenfurt, Austria
| | - Simona Bota
- Departement of Internal Medicine and Gastroenterology (IMuG), Hepatology, Endocrinology, Rheumatology and Nephrology and Emergency Medicine (ZAE) with Centralized Endoscopy Service, Klinikum Klagenfurt am Wörthersee, Klagenfurt, Austria
| | - Mathilde Kutilek
- Departement of Internal Medicine 2, Gastroenterology and Hepatology and Rheumatology, University Hospital St. Pölten, Karl Landsteiner University of Health Sciences, St. Pölten, Austria
| | - Gerolf Essler
- Departement of Internal Medicine and Gastroenterology (IMuG), Hepatology, Endocrinology, Rheumatology and Nephrology and Emergency Medicine (ZAE) with Centralized Endoscopy Service, Klinikum Klagenfurt am Wörthersee, Klagenfurt, Austria
| | - Christian Urak
- Departement of Internal Medicine and Gastroenterology (IMuG), Hepatology, Endocrinology, Rheumatology and Nephrology and Emergency Medicine (ZAE) with Centralized Endoscopy Service, Klinikum Klagenfurt am Wörthersee, Klagenfurt, Austria
| | - Julian Prosenz
- Departement of Internal Medicine 2, Gastroenterology and Hepatology and Rheumatology, University Hospital St. Pölten, Karl Landsteiner University of Health Sciences, St. Pölten, Austria
| | - Jutta Weber-Eibel
- Departement of Internal Medicine and Gastroenterology (IMuG), Hepatology, Endocrinology, Rheumatology and Nephrology and Emergency Medicine (ZAE) with Centralized Endoscopy Service, Klinikum Klagenfurt am Wörthersee, Klagenfurt, Austria
| | - Andreas Maieron
- Departement of Internal Medicine 2, Gastroenterology and Hepatology and Rheumatology, University Hospital St. Pölten, Karl Landsteiner University of Health Sciences, St. Pölten, Austria
| | - Markus Peck-Radosavljevic
- Departement of Internal Medicine and Gastroenterology (IMuG), Hepatology, Endocrinology, Rheumatology and Nephrology and Emergency Medicine (ZAE) with Centralized Endoscopy Service, Klinikum Klagenfurt am Wörthersee, Klagenfurt, Austria
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Borrelli de Andreis F, Mascagni P, Schepis T, Attili F, Tringali A, Costamagna G, Boškoski I. Prevention of post-ERCP pancreatitis: current strategies and novel perspectives. Therap Adv Gastroenterol 2023; 16:17562848231155984. [PMID: 36895283 PMCID: PMC9989421 DOI: 10.1177/17562848231155984] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 01/23/2023] [Indexed: 03/08/2023] Open
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) is an advanced endoscopic procedure that might lead to severe adverse events. Post-ERCP pancreatitis (PEP) is the most common post-procedural complication, which is related to significant mortality and increasing healthcare costs. Up to now, the prevalent approach to prevent PEP consisted of employing pharmacological and technical expedients that have been shown to improve post-ERCP outcomes, such as the administration of rectal nonsteroidal anti-inflammatory drugs, aggressive intravenous hydration, and the placement of a pancreatic stent. However, it has been reported that PEP originates from a more complex interaction of procedural and patient-related factors. Appropriate ERCP training has a pivotal role in PEP prevention strategy, and it is not a chance that a low PEP rate is universally considered one of the most relevant indicators of proficiency in ERCP. Scant data on the acquisition of skills during the ERCP training are currently available, although some efforts have been recently done to shorten the learning curve by way of simulation-based training and demonstrate competency by meeting technical requirements as well as adopting skill evaluation scales. Besides, the identification of adequate indications for ERCP and accurate pre-procedural risk stratification of patients might help to reduce PEP occurrence regardless of the endoscopist's technical abilities, and generally preserve safety in ERCP. This review aims at delineating current preventive strategies and highlighting novel perspectives for a safer ERCP focusing on the prevention of PEP.
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Affiliation(s)
- Federica Borrelli de Andreis
- First Department of Internal Medicine, Fondazione IRCCS San Matteo Hospital, University of Pavia, Pavia, Italy.,Gastroenterology Unit, Istituti Clinici Maugeri, University of Pavia, Pavia, Italy.,Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Pietro Mascagni
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Institute of Image-Guided Surgery, IHU-Strasbourg, France
| | - Tommaso Schepis
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Fabia Attili
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Andrea Tringali
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Guido Costamagna
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Centre for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica Del Sacro Cuore di Roma, Roma, Italy
| | - Ivo Boškoski
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, Rome, 00168, Italy.,IHU Strasbourg 1, Place de l'Hopital 67091 Strasbourg Cedex, France.,Centre for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica Del Sacro Cuore di Roma, Roma, Italy
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Tanisaka Y, Mizuide M, Fujita A, Jinushi R, Ogawa T, Katsuda H, Saito Y, Miyaguchi K, Mashimo Y, Ryozawa S. Competence development of trainees performing short-type single-balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2022; 29:1316-1326. [PMID: 35594030 DOI: 10.1002/jhbp.1187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/01/2022] [Accepted: 04/17/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES This study aimed to evaluate the trainees' practice and learning curve in short-type single-balloon enteroscopy (short SBE)-assisted endoscopic retrograde cholangiopancreatography (ERCP) for patients with surgically altered anatomy (SAA) and determine how to train these trainees. METHODS The data of short SBE-assisted ERCP procedures between September 2011 and June 2021 were analyzed. RESULTS Three trainees and 180 cases were included in the analysis. Each trainee performed 60 cases between April 2016 and June 2021. The trainees' completion rate was 73.9% (95% confidence interval [CI], 66.8-80.1%). Adverse events occurred in 5.0% of cases (95% CI, 2.3-9.3%). The trainee who experienced colonoscopy and ERCP the most achieved better outcomes of enteroscopy success (reaching the target site) and trainee's completion rates than those of the others (P = .03 and .02, respectively). The learning curve for trainee's completion showed a significant improvement after 60 cases (P = .001). Multiple logistic regression analysis indicated that Roux-en-Y reconstruction was the factor affecting trainees' completion failure. CONCLUSIONS Short SBE-assisted ERCP trainees has a substantial learning curve. If trainees do not have much experience with colonoscopy and ERCP procedures, it may be beneficial for them to start performing short SBE-assisted ERCP procedures on non-Roux-en-Y reconstruction cases.
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Affiliation(s)
- Yuki Tanisaka
- Department of Gastroenterology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Masafumi Mizuide
- Department of Gastroenterology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Akashi Fujita
- Department of Gastroenterology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Ryuhei Jinushi
- Department of Gastroenterology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Tomoya Ogawa
- Department of Gastroenterology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Hiromune Katsuda
- Department of Gastroenterology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Yoichi Saito
- Department of Gastroenterology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Kazuya Miyaguchi
- Department of Gastroenterology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Yumi Mashimo
- Department of Gastroenterology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Shomei Ryozawa
- Department of Gastroenterology, Saitama Medical University International Medical Center, Hidaka, Japan
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Figueiredo Ferreira M, Garces-Duran R, Eisendrath P, Devière J, Deprez P, Monino L, Van Laethem JL, Borbath I. EUS-guided radiofrequency ablation of pancreatic/peripancreatic tumors and oligometastatic disease: an observational prospective multicenter study. Endosc Int Open 2022; 10:E1380-E1385. [PMID: 36262511 PMCID: PMC9576329 DOI: 10.1055/a-1922-4536] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 08/09/2022] [Indexed: 10/25/2022] Open
Abstract
Background and study aims Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) is an emerging and minimally invasive technique that seems promising for treatment of focal pancreatic and peripancreatic lesions. Our aim was to prospectively evaluate the feasibility, safety, and technical and clinical success of pancreatic and extra-pancreatic EUS-RFA. Patients and methods We prospectively collected clinical and technical data for all patients who underwent EUS-RFA at two Belgian academic centers from June 2018 to February 2022. Feasibility, adverse events (AEs), and follow-up were also assessed. Results Twenty-nine patients were included, accounting for 35 lesions: 10 non-functioning neuroendocrine tumors (29 %), 13 pancreatic insulinomas (37 %), one adenocarcinoma (3 %), and 11 intra-pancreatic and extra-pancreatic metastatic lesions (31 %). Technical success was achieved in 100 % of cases, with a median of three power applications per lesion (interquartile range 2). The majority of patients (59 %) presented no collateral effects, three (10.3 %) developed non-severe acute pancreatitis, and four (14 %) had mild abdominal pain. At 6 months follow-up (n = 25), 36 % of patients showed radiological complete response, 16 % presented a significant partial response and 48 % showed < 50 % decrease in diameter. At 12 months (n = 20), 30 % showed complete necrosis and 15 % > 50 % decrease in diameter. Hypoglycemia related to insulinoma was immediately corrected in all 13 cases, with no recurrence during follow-up. Conclusions EUS-RFA is feasible, safe, and effective for treatment of pancreatic and peripancreatic tumors. Larger and longer multicenter prospective studies are warranted to establish its role in management of focal pancreatic lesions and oligometastatic disease. Symptomatic insulinoma currently represent the best indication.
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Affiliation(s)
- Mariana Figueiredo Ferreira
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles, Belgium,Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Saint-Pierre University Hospital, Université Libre de Bruxelles, Belgium
| | - Rodrigo Garces-Duran
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Cliniques Universitaires St. Luc, Université Catholique de Louvain, Belgium
| | - Pierre Eisendrath
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Saint-Pierre University Hospital, Université Libre de Bruxelles, Belgium
| | - Jacques Devière
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles, Belgium
| | - Pierre Deprez
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Cliniques Universitaires St. Luc, Université Catholique de Louvain, Belgium
| | - Laurent Monino
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Cliniques Universitaires St. Luc, Université Catholique de Louvain, Belgium
| | - Jean-Luc Van Laethem
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles, Belgium
| | - Ivan Borbath
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Cliniques Universitaires St. Luc, Université Catholique de Louvain, Belgium
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Khan U, Khan R, Benchimol E, Salim M, Telford J, Enns R, Mohamed R, Forbes N, Sandha G, Kohansal A, Mosko J, Chatterjee A, May G, Waschke K, Barkun A, James PD. Learning curves in ERCP during advanced endoscopy training: a Canadian multicenter prospective study. Endosc Int Open 2022; 10:E1174-E1180. [PMID: 36118648 PMCID: PMC9473840 DOI: 10.1055/a-1795-9037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 12/13/2021] [Indexed: 10/31/2022] Open
Abstract
Background and study aims Growing emphasis on quality and patient safety has supported the shift toward competency-based medical education for advanced endoscopy trainees (AETs). In this study, we aimed to examine Canadian AETs learning curves and achievement of competence using an ERCP assessment tool with strong evidence of validity. Methods This prospective study was conducted at five institutions across Canada from 2017-2018. Data on every fifth procedure performed by trainees were collected using the United Kingdom Joint Advisory Joint Advisory Group of Gastrointestinal Endoscopy (JAG) ERCP Direct Observation of Procedural Skills (DOPS) tool, which includes a four-point rating scale for 27 items. Cumulative sum (CUSUM) analysis was used to create learning curves for overall supervision ratings and ERCP DOPS items by plotting scores for procedures performed during training. Results Eleven trainees who were evaluated for 261 procedures comprised our sample. The median number of evaluations by site was 49 (Interquartile range (IQR) 31-76) and by trainee was 15 (IQR 11-45). The overall cannulation rate by trainees was 82 % (241/261), and the native papilla cannulation rate was 78 % (149/191). All trainees achieved competence in the "overall supervision" domain of the ERCP DOPS by the end of their fellowship. Trainees achieved competency in all individual domains, except for tissue sampling and sphincteroplasty. Conclusions Canadian AETs are graduating from fellowship programs with acceptable levels of competence for overall ERCP performance and for the most specific tasks. Learning curves may help identify areas of deficiency that may require supplementary training, such as tissue sampling.
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Affiliation(s)
- Usman Khan
- Division of General Surgery, Department of Surgery, University of Toronto
| | - Rishad Khan
- Department of Medicine, University of Toronto
| | - Eric Benchimol
- Division of Gastroenterology, Hepatology, and Nutrition, the Hospital for Sick Children, University of Toronto
| | - Misbah Salim
- Division of Gastroenterology, University Health Network, University of Toronto
| | - Jennifer Telford
- Division of Gastroenterology and Hepatology, Department of Medicine, University of British Columbia
| | - Robert Enns
- Division of Gastroenterology and Hepatology, Department of Medicine, University of British Columbia
| | - Rachid Mohamed
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary
| | - Nauzer Forbes
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary
| | - Gurpal Sandha
- Division of Gastroenterology and Hepatology, University of Alberta Hospital, University of Alberta
| | - Ali Kohansal
- Division of Digestive Care and Endoscopy, Department of Medicine, Dalhousie University
| | - Jeffrey Mosko
- Division of Gastroenterology, St. Michael’s Hospital, University of Toronto
| | - Avijit Chatterjee
- Division of Gastroenterology and Hepatology, The Ottawa Hospital, University of Ottawa
| | - Gary May
- Division of Gastroenterology, St. Michael’s Hospital, University of Toronto
| | - Kevin Waschke
- Division of Gastroenterology, McGill University Health Centre, McGill University
| | - Alan Barkun
- Division of Gastroenterology, McGill University Health Centre, McGill University
| | - Paul D. James
- Division of Gastroenterology, University Health Network, University of Toronto
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Lin YC, Yen HH, Huang SP, Shih KL, Chen YY. Comparison of Adverse Events of Different Endoscopic Ultrasound-Guided Tissue Acquisition Methods: A Single-Center Retrospective Analysis. Diagnostics (Basel) 2022; 12:diagnostics12092123. [PMID: 36140524 PMCID: PMC9498281 DOI: 10.3390/diagnostics12092123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 08/25/2022] [Accepted: 08/27/2022] [Indexed: 11/16/2022] Open
Abstract
The efficacy of new generation endoscopic ultrasound-guided biopsy needles has been promising in recent years. Yet, comparing these needles’ diagnostic yield and safety to conventional needles is not well-known. Our study aims to compare the adverse events of endoscopic ultrasound-guided tissue acquisition (EUS-TA) with different types of needles, including FNA needles, FNB needles with a Franseen tip and FNB needles with a reverse bevel. Furthermore, we will analyze the risk factors, including tumor vascularity, different needle types, and the underlying disease, which may impact the safety of the procedures. From May 2014 to December 2021, 192 consecutive EUS-TAs were performed on pancreatic and peripancreatic lesions in our hospital using different types of FNA and FNB needles. We retrospectively reviewed the data and identified the risk factors for EUS-TA-related complications. As a result, the hypervascular tumor is a significant risk factor for adverse events in our multivariate analysis, with an odds ratio of 4.96 (95% CI 1.33–18.47), while liver cirrhosis is one of the risk factors for adverse events during EUS-TA, with an odds ratio of 5.3 (95% CI 1.1–25.6). However, the risk of adverse events did not increase using Franseen-tip needles, compared to conventional FNA or FNB needles with a reverse bevel. In conclusion, we must be more cautious in patients with liver cirrhosis and hypervascular tumors, such as pancreatic neuroendocrine tumors, when performing EUS-guided tissue acquisition.
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Affiliation(s)
- Yen-Chih Lin
- Division of Gastroenterology, Changhua Christian Hospital, Changhua 500, Taiwan
- College of Medicine, National Chung Hsing University, Taichung 400, Taiwan
| | - Hsu-Heng Yen
- Division of Gastroenterology, Changhua Christian Hospital, Changhua 500, Taiwan
- College of Medicine, National Chung Hsing University, Taichung 400, Taiwan
- Department of Electrical Engineering, Chung Yuan Christian University, Taoyuan 320, Taiwan
- General Education Center, Chienkuo Technology University, Changhua 500, Taiwan
- Correspondence:
| | - Siou-Ping Huang
- Division of Gastroenterology, Changhua Christian Hospital, Changhua 500, Taiwan
| | - Kai-Lun Shih
- Division of Gastroenterology, Changhua Christian Hospital, Changhua 500, Taiwan
| | - Yang-Yuan Chen
- Division of Gastroenterology, Changhua Christian Hospital, Changhua 500, Taiwan
- Department of Hospitality Management, MingDao University, Changhua 500, Taiwan
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Shah-Khan SM, Zhao E, Tyberg A, Sarkar S, Shahid HM, Duarte-Chavez R, Gaidhane M, Kahaleh M. Endoscopic Ultrasound-Directed Transgastric ERCP (EDGE) Utilization of Trends Among Interventional Endoscopists. Dig Dis Sci 2022; 68:1167-1177. [PMID: 35947304 DOI: 10.1007/s10620-022-07650-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 07/29/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND Endoscopic ultrasound-directed transgastric ERCP (EDGE) has become standard-of-care therapy at many centers for pancreaticobiliary disease in patients with Roux-en-Y Gastric Bypass. In this study, we aimed to evaluate the opinions and practices of endoscopists who perform EDGE. METHODS A 22-question utilization of EDGE survey was sent to 36 advanced endoscopists at tertiary care centers in the United States. The two-section survey included questions regarding advanced endoscopy volume and training at the respective facilities, and questions on specific details of EDGE utilization. RESULTS Among 36 interventional endoscopists (IE) surveyed, 14 (39%) reported performing > 1000 ERCPs annually. Thirty (83%) offered EDGE as an option for Roux-en-Y gastric bypass patients with previous cholecystectomy. Other options offered included: 19 (53%) offered Laparoscopy-assisted ERCP (LA-ERCP), 7 (19%) offered Single-Balloon ERCP (SBE), and 10 (28%) offered percutaneous drainage (PTC). Twenty (56%) IE performed 10 or less EDGE procedures, while 16 (44%) performed 11 or more. Single-session EDGE was performed by 7 (19%) IE, while 15 (42%) performed dual session, and 13 (36%) performed both. 19 (53%) actively closed fistulas while 17 (47%) let them close spontaneously. Thirty one (86%) reported a technical success rate of 91% to 100%. The most frequently reported immediate adverse event post-procedurally was abdominal pain, reported by 17 IE (47%). Weight gain was reported by 2 IE (6%). CONCLUSION EDGE continues to gain in popularity as an option for Roux-en-Y gastric bypass patients requiring pancreaticobiliary interventions, with 24/36 IE (67%) believing that it should be the new standard. In addition, most report a low frequency of post-procedural weight gain. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT05041608.
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Affiliation(s)
- Sardar M Shah-Khan
- Department of Gastroenterology, Rutgers Robert Wood Johnson Medical School, Robert Wood Johnson University Hospital, New Brunswick, NJ, 08901, USA
| | - Eric Zhao
- Department of Gastroenterology, Rutgers Robert Wood Johnson Medical School, Robert Wood Johnson University Hospital, New Brunswick, NJ, 08901, USA
| | - Amy Tyberg
- Department of Gastroenterology, Rutgers Robert Wood Johnson Medical School, Robert Wood Johnson University Hospital, New Brunswick, NJ, 08901, USA
| | - Sardar Sarkar
- Department of Gastroenterology, Rutgers Robert Wood Johnson Medical School, Robert Wood Johnson University Hospital, New Brunswick, NJ, 08901, USA
| | - Haroon M Shahid
- Department of Gastroenterology, Rutgers Robert Wood Johnson Medical School, Robert Wood Johnson University Hospital, New Brunswick, NJ, 08901, USA
| | - Rodrigo Duarte-Chavez
- Department of Gastroenterology, Rutgers Robert Wood Johnson Medical School, Robert Wood Johnson University Hospital, New Brunswick, NJ, 08901, USA
| | - Monica Gaidhane
- Department of Gastroenterology, Rutgers Robert Wood Johnson Medical School, Robert Wood Johnson University Hospital, New Brunswick, NJ, 08901, USA
| | - Michel Kahaleh
- Department of Gastroenterology, Rutgers Robert Wood Johnson Medical School, Robert Wood Johnson University Hospital, New Brunswick, NJ, 08901, USA.
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Yan Y, Ma Z, Ji X, Liu J, Ji K, Li S, Wu Q. A potential decision-making algorithm based on endoscopic ultrasound for staging early gastric cancer: a retrospective study. BMC Cancer 2022; 22:761. [PMID: 35831843 PMCID: PMC9281103 DOI: 10.1186/s12885-022-09870-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 07/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical staging of gastric cancer (GC) before treatment is essential. Endoscopic ultrasound (EUS) is a recommended staging tool, but its efficacy remains controversial. Our previous prospective study evaluated the potential value of EUS for T staging and presented discrepancies. In this study, we aimed to evaluate the efficacy of EUS in T staging by comparing it with pathological staging. We analyze the factors that can potentially affect accuracy to identify suitable subgroups for EUS staging. METHODS Data from a total of 1763 consecutive patients with GC from January 2015 to December 2017 were analyzed. Results from EUS and pathological T staging were compared. The factors that might affect EUS's accuracy were analyzed. RESULTS The sensitivity, specificity, positive predictive value, and negative predictive value of EUS in patients with early GC were 62.08%, 96.13%, 90.94%, and 80.21%, respectively. The accuracy rates of uT1, uT2-uT4, and uT3-uT4 were 90.94%, 79.02%, and 78.39%, respectively. In multivariate analysis, underestimation was more likely to be observed in patients with tumors located in the middle or upper third of the stomach. Overestimation was more likely to be observed in patients with tumors located in the lower third or those without ulcer. Other factors affecting accuracy included ulcer, differentiation, larger size and undergoing surgery. CONCLUSION Our findings highlight the role of EUS in determining the T staging of GC. Overestimation and underestimation in T-staging were significantly associated with the tumor location in early GC, and a decision-making algorithm was proposed for clinical practice in early cancers based on these findings.
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Affiliation(s)
- Yan Yan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Endoscopy, Peking University Cancer Hospital & Institute, #52 Fucheng Road Haidian District, Beijing, China
| | - Zhonghua Ma
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Endoscopy, Peking University Cancer Hospital & Institute, #52 Fucheng Road Haidian District, Beijing, China
| | - Xin Ji
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Center of Gastrointestinal Cancer, Peking University Cancer Hospital & Institute, Beijing, China
| | - Jiawei Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Center of Gastrointestinal Cancer, Peking University Cancer Hospital & Institute, Beijing, China
| | - Ke Ji
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Center of Gastrointestinal Cancer, Peking University Cancer Hospital & Institute, Beijing, China
| | - Shijie Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Endoscopy, Peking University Cancer Hospital & Institute, #52 Fucheng Road Haidian District, Beijing, China
| | - Qi Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Endoscopy, Peking University Cancer Hospital & Institute, #52 Fucheng Road Haidian District, Beijing, China.
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Dhir V, Shah R, Udawat P. Endoscopic Ultrasound-Guided Biliary Interventions. Gastrointest Endosc Clin N Am 2022; 32:507-525. [PMID: 35691694 DOI: 10.1016/j.giec.2022.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Endoscopic ultrasound (EUS)-guided biliary interventions have evolved to become an integral part of advanced gastrointestinal endoscopy units. EUS-guided biliary drainage is an accepted alternative for patients with failed ERCP or altered surgical anatomy. The potential advantages of EUS-guided interventions include choice of biliary access from stomach or duodenum, choice of stent exit in stomach and duodenum, and possibility of avoiding traversing through the obstruction. A variety of procedures have been described depending on the level of obstruction. Maximum evidence is available for distal malignant obstruction, and more studies are needed for hilar obstruction and benign indications.
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Affiliation(s)
- Vinay Dhir
- Division of Endosonography, Institute of Digestive and Liver Care, SL Raheja Hospital-A Fortis Associate, Mumbai 400016, India.
| | - Rahul Shah
- Division of Endosonography, Institute of Digestive and Liver Care, SL Raheja Hospital-A Fortis Associate, Mumbai 400016, India
| | - Priyanka Udawat
- Division of Endosonography, Institute of Digestive and Liver Care, SL Raheja Hospital-A Fortis Associate, Mumbai 400016, India
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Bhurwal A, Mutneja H, Goel A, Bansal V, Patel A, Brahmbhatt B, Sarkar A. No Significant Difference in Post-ERCP Bleeding Rates Between Dual Antiplatelet Agents and Aspirin Alone: A Systematic Review and Meta-analysis. J Clin Gastroenterol 2022; 56:546-551. [PMID: 34028396 DOI: 10.1097/mcg.0000000000001559] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 03/17/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Several professional society guidelines suggest holding antiplatelet agents before high-risk procedures. However, there is lack of high-grade evidence to support the recommendation as most of the studies have been single center with small sample sizes. We aimed to perform the first systematic review and meta-analysis comparing dual antiplatelet therapy (DAPT) versus aspirin alone in terms of postendoscopic retrograde cholangiopancreatography (ERCP) bleeding. METHODS Three independent reviewers performed a comprehensive review of all original articles published from inception to May 2020, evaluating the post-ERCP bleeding rate in setting of DAPT. Primary outcomes were the overall post-ERCP bleeding rate with the use of dual antiplatelet therapy; comparison of post-ERCP bleeding rate in patients with DAPT versus aspirin alone. Secondary outcomes were comparison of immediate and delayed post-ERCP bleeding outcomes in the 2 cohorts. RESULTS Six studies were included after a thorough search was concluded using the key words. The pooled analysis of studies revealed an overall post-ERCP bleeding rate of 5.7% (95% confidence interval: 3-10.6) on sustained DAPT. Post-ERCP bleeding in DAPT Cohort was not significantly higher as compared with aspirin only Cohort (odds ratio: 1.14, 95% confidence interval: 0.46-2.81). The immediate bleeding and delayed bleeding rates cannot be generalized due to low number of studies. CONCLUSIONS The first systematic review and meta-analysis showed that post-ERCP bleeding rates are not significantly higher in DAPT cohort as compared with aspirin alone. Therefore, the risk of bleeding is less likely related to the antiplatelet agents and more likely related to the procedure itself.
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Affiliation(s)
- Abhishek Bhurwal
- Division of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson School of Medicine, New Brunswick, NJ
| | - Hemant Mutneja
- Division of Gastroenterology and Hepatology, John H. Stroger Cook County Hospital, Chicago, IL
| | - Akshay Goel
- Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Vikas Bansal
- Division of Pulmonary and Critical Care, Mayo Clinic, Rochester, MN
| | - Anish Patel
- Division of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson School of Medicine, New Brunswick, NJ
| | - Bhaumik Brahmbhatt
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL
| | - Avik Sarkar
- Division of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson School of Medicine, New Brunswick, NJ
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de-Madaria E, Mira JJ, Carrillo I, Afif W, Ang D, Antelo M, Bollipo S, Castells A, Chahal P, Heinrich H, Law JK, van Leerdam ME, Lens S, Pannala R, Park SH, Rabiee A, Savarino EV, Singh VK, Vargo J, Charabaty A, Drenth JPH. The present and future of gastroenterology and hepatology: an international SWOT analysis (the GASTROSWOT project). Lancet Gastroenterol Hepatol 2022; 7:485-494. [PMID: 35247318 DOI: 10.1016/s2468-1253(21)00442-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/18/2021] [Accepted: 11/19/2021] [Indexed: 06/14/2023]
Abstract
GASTROSWOT is a strategic analysis of the current and projected states of the different subspecialties in gastroenterology that aims to provide guidance for research, clinical, and financial planning in gastroenterology. We executed a consensus-based international strengths, weaknesses, opportunities, and threats (SWOT) analysis. Four general coordinators, six field coordinators, and 12 experts participated in the study. SWOTs were provided for the following fields: neurogastroenterology, functional gastrointestinal disorders, and upper gastrointestinal diseases; inflammatory bowel disease; pancreatology and biliary diseases; endoscopy; gastrointestinal oncology; and hepatology. The GASTROSWOT analysis highlights the following in the current state of the field of gastroenterology: the incidence and complexity of several gastrointestinal diseases, including malignancies, are increasing; the COVID-19 pandemic has affected patient care on several levels; and with the advent of technical innovations in gastroenterology, a well trained workforce and strategic planning are required to optimise health-care utilisation. The analysis calls attention to the following in the future of gastroenterology: artificial intelligence and the use of big data will speed up discovery and smarter health-care provision in the field; the growth and diversification of gastroenterological specialties will improve specialised care for patients, but could promote fragmentation of care and health system inefficiencies; and furthermore, thoughtful planning is needed to reach an effective balance between the need for subspecialists and the value of general gastroenterology services.
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Affiliation(s)
- Enrique de-Madaria
- Gastroenterology Department, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research, Alicante, Spain
| | - José J Mira
- Atenena Research Group, Foundation for the Promotion of Health and Biomedical Research of Valencia Region, FISABAO, Sant Joan d'Alacant, Spain; Department of Health Psychology, Miguel Hernández University of Elche, Elche, Spain
| | - Irene Carrillo
- Atenena Research Group, Foundation for the Promotion of Health and Biomedical Research of Valencia Region, FISABAO, Sant Joan d'Alacant, Spain; Department of Health Psychology, Miguel Hernández University of Elche, Elche, Spain
| | - Waqqas Afif
- Division of Gastroenterology, McGill University Health Centre, Montreal, QC, Canada
| | - Daphne Ang
- Department of Gastroenterology, Changi General Hospital, Singapore, Singapore
| | - Marina Antelo
- Oncology Section, Dr C Bonorino Udaondo Gastroenterology Hospital, Buenos Aires, Argentina
| | - Steven Bollipo
- Department of Gastroenterology, John Hunter Hospital, Newcastle, NSW, Australia; School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Antoni Castells
- Gastroenterology Department, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain; Hospital Clinic of Barcelona, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
| | - Prabhleen Chahal
- Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Henriette Heinrich
- Stadtspital Waid und Triemli Abteilung für Gastroenterologie, University of Zurich, Zurich, Switzerland
| | | | - Monique E van Leerdam
- Department of Gastrointestinal Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands; Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, Netherlands
| | - Sabela Lens
- Liver Unit, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
| | - Rahul Pannala
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - San Hyoung Park
- Department of Gastroenterology, and Inflammatory Bowel Disease Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Atoosa Rabiee
- Division of Gastroenterology and Hepatology, Washington DC Veterans Affairs Medical Center, Washington, DC, USA
| | - Edoardo V Savarino
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Vikesh K Singh
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - John Vargo
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Aline Charabaty
- Division of Gastroenterology, Sibley Memorial Hospital, Johns Hopkins University, Washington, DC, USA
| | - Joost P H Drenth
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, Netherlands.
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Fugazza A, Fabbri C, Di Mitri R, Petrone MC, Colombo M, Cugia L, Amato A, Forti E, Binda C, Maida M, Sinagra E, Repici A, Tarantino I, Anderloni A, Donato G, de Nucci G, Manno M, Pollino V, Macchiarelli R, Leone N, Badas R, Lovera M, Armellini E, Redaelli A, Mangiavillano B, Brancaccio ML, Attili F, Togliani T, Aragona G, Khalaf K, Conte E. EUS-guided choledochoduodenostomy for malignant distal biliary obstruction after failed ERCP: a retrospective nationwide analysis. Gastrointest Endosc 2022; 95:896-904.e1. [PMID: 34995640 DOI: 10.1016/j.gie.2021.12.032] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 12/25/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS EUS-guided choledochoduodenostomy (EUS-CDS) with a lumen-apposing metal stent (LAMS) has been proposed as an alternative procedure in patients with distal malignant biliary obstruction (DMBO) and failed ERCP. METHODS This multicenter, retrospective analysis included all cases of EUS-CDS with LAMS performed in patients with DMBO and failed ERCP in 23 Italian centers from January 2016 to July 2020. Primary endpoints were technical and clinical success. Secondary endpoints were the assessment of the adverse event (AE) rate and variables associated with technical success. RESULTS Two hundred fifty-six patients (44.9% women) with a mean age of 73.9 ± 12.6 years were included in the study. The most common etiology of DMBO was pancreatic adenocarcinoma (75%), followed by ampullary cancer (8.6%) and cholangiocarcinoma (6.6%). The common bile duct median diameter was 17.3 ± 3.9 mm. Technical and clinical success were achieved in 239 of 256 (93.3%), and 230 of 239 (96.2%) patients, respectively. The mean follow-up was 151 ± 162 days. Twenty-seven AEs occurred in 25 of 239 patients (10.5%) (3 mild, 21 moderate, and 3 severe). No fatal AEs occurred. Reinterventions to manage AEs with endoscopic or radiologic procedures occurred in 22 patients (9.2%). CONCLUSIONS The results of our study show that EUS-CDS with LAMSs in patients with DMBO and failed ERCP represent a viable alternative in terms of effectiveness and safety with acceptable AE rates. (Clinical trial registration number: NCT03903523.).
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Affiliation(s)
- Alessandro Fugazza
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital-IRCCS, Milan, Italy
| | - Carlo Fabbri
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì-Cesena, Italy
| | - Roberto Di Mitri
- Gastroenterology and Endoscopy Unit, ARNAS Civico Hospital, Palermo, Italy
| | - Maria Chiara Petrone
- Pancreato-Biliary Endoscopy and EUS Division, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Milan, Italy
| | - Matteo Colombo
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital-IRCCS, Milan, Italy
| | - Luigi Cugia
- Division of Gastroenterology and Digestive Endoscopy (Department of Emergency), Azienda Ospedaliero Universitaria Sassari, Sassari, Italy
| | - Arnaldo Amato
- Department of Gastroenterology, Valduce Hospital, Como, Italy
| | - Edoardo Forti
- Digestive and Interventional Endoscopy Unit, Ospedale Ca'Granda Niguarda, Milan, Italy
| | - Cecilia Binda
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì-Cesena, Italy
| | - Marcello Maida
- Gastroenterology and Endoscopy Unit, S Elia-Raimondi Hospital, Caltanissetta, Italy
| | - Emanuele Sinagra
- Gastroenterology & Endoscopy Unit, Fondazione Istituto G Giglio, Cefalù, Italy
| | - Alessandro Repici
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital-IRCCS, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Ilaria Tarantino
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT, Palermo, Italy
| | - Andrea Anderloni
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital-IRCCS, Milan, Italy
| | | | - Giulio Donato
- Department of Gastroenterology, 'Maggiore della Carità' Hospital, Novara, Italy
| | - Germana de Nucci
- Gastroenterology and Endoscopy Unit, ASST Rhodense, Garbagnate Milanese (MI)
| | - Mauro Manno
- Gastroenterology and Digestive Endoscopy Unit, USL Modena, Italy
| | | | | | - Nicola Leone
- Digestive Endoscopy Unit, Humanitas Gradenigo, Turin, Italy
| | - Roberta Badas
- Digestive Endoscopy Unit, University Hospital, Cagliari, Italy
| | - Mauro Lovera
- Digestive Endoscopy Unit, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Elia Armellini
- Digestive Endoscopy Unit, ASST Bergamo Est, Seriate, Bergamo
| | | | - Benedetto Mangiavillano
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy; Gastrointestinal Endoscopy Unit, Humanitas - Mater Domini, Castellanza, Italy
| | | | - Fabia Attili
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Thomas Togliani
- Gastroenterology and Endoscopy Unit, ASST Carlo Poma, Mantua, Italy
| | - Giovanni Aragona
- Gastroenterology and Hepatology Unit, Guglielmo da Saliceto Hospital, Piacenza, Emilia-Romagna, Italy
| | - Kareem Khalaf
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
| | - Elisabetta Conte
- Gastroenterology and Endoscopy Unit, ARNAS Civico Hospital, Palermo, Italy
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Theunissen F, van der Wiel SE, Ter Borg PCJ, Koch AD, Ouwendijk RJT, Slangen RME, Siersema PD, Bruno MJ. Implementation of mandatory ERCP registration in The Netherlands and compliance with European Society of Gastrointestinal Endoscopy performance measures: a multicenter database study. Endoscopy 2022; 54:262-267. [PMID: 34107538 DOI: 10.1055/a-1499-7477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND In 2018, the European Society of Gastrointestinal Endoscopy (ESGE) and United European Gastroenterology (UEG) published quality performance measures for endoscopic retrograde cholangiopancreatography (ERCP). Since January 2016, all endoscopists in the Netherlands have been required to register all ERCP procedures in a nationwide quality registry. This study aimed to evaluate the procedural success rates of ERCP after the implementation of mandatory national registration and to compare these with the ESGE quality performance measures. METHODS This study was conducted with data from a multicenter endoscopy database. Data from 2019 and 2020 were analyzed. The primary outcome was ERCP procedural outcome. ESGE performance measures that could be evaluated were the percentage of successful bile duct cannulations in patients with virgin papillary anatomy; successful stent placement for a biliary obstruction located below the liver hilum; and complete removal of bile duct stones (< 10 mm). RESULT In total, 5295 ERCPs performed in 11 centers were included for analysis. The overall procedural success rate was 89.1 %. Successful biliary cannulation in patients with a virgin papilla was 90.3 % in nonacademic and 92.4 % in academic centers. The rates of successful stent placement in patients with a biliary obstruction located below the liver hilum were 97.0 % in nonacademic and 98.2 % in academic centers, and of successful bile duct stone extraction were 97.9 % in both nonacademic and academic centers. CONCLUSIONS The quality of ERCPs performed met five of the six evaluated ESGE performance measures. The 95 % target for successful biliary cannulation in patients with virgin papillary anatomy in academic centers was not met. Mandatory registration provides valuable insight into ERCP performance rates.
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Affiliation(s)
- Felix Theunissen
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Sophia E van der Wiel
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Pieter C J Ter Borg
- Department of Gastroenterology and Hepatology, Ikazia Ziekenhuis, Rotterdam, The Netherlands
| | - Arjun D Koch
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Rob J T Ouwendijk
- Department of Gastroenterology and Hepatology, ADRZ, Goes, The Netherlands
| | - Rob M E Slangen
- Department of Gastroenterology and Hepatology, HagaZiekenhuis, The Hague, The Netherlands
| | - Peter D Siersema
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marco J Bruno
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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A novel and effective EUS training program that enables visualization of the learning curve: Educational Program of Kindai system (EPOK). VideoGIE 2022; 7:165-168. [PMID: 35585898 PMCID: PMC9108189 DOI: 10.1016/j.vgie.2022.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Deng X, Liao R, Pan L, Du C, Wu Q. Second endoscopic retrograde cholangiopancreatography after failure of initial biliary cannulation: A single institution retrospective experience. Exp Ther Med 2022; 23:297. [PMID: 35340881 PMCID: PMC8931629 DOI: 10.3892/etm.2022.11226] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/01/2022] [Indexed: 11/27/2022] Open
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) is not always successful when difficult biliary cannulation occurs. A second ERCP seems to be a worthwhile option following initial failure cannulation; however, relevant data are limited. Thus, the aim of the present study was to determine the outcomes of repeating ERCP in patients in whom the first biliary cannulation with or without precut sphincterotomy failed. It retrospectively analyzed 4,136 patients who underwent an initial biliary access between June 2016 and September 2020. Data from our databases were analyzed. Efficacy was based on the cannulation rate of the second ERCP and safety was assessed in terms of adverse events. Of 94 patients, 56 (59.6%) underwent a second ERCP and the success rate in biliary cannulation was 83.9% (47 of 56). The median operative time in the second ERCP was shorter than that in the initial procedure (47 vs. 65 min, P<0.001). A total of 5 patients (8.9%) suffered from mild ERCP-associated complications following the second ERCP. Compared with patients that did not undergo a second ERCP, patients that underwent a second ERCP had a lower 30-day mortality rate (13.2 vs. 1.8%, P=0.038). In addition, by univariate and multivariate analysis, it was observed that normal preoperative serum bilirubin levels and an interval time of <3 days were correlated with the cannulation failure of a second ERCP (OR=9.211, P=0.019, OR=6.765, P=0.041, respectively). A second ERCP following failure of an initial biliary cannulation appears to be safe and effective. For most clinically stable patients with an unsuccessful initial ERCP, a second ERCP after 2-4 days may be an optimal strategy. Preoperative normal serum bilirubin levels may be a risk factor that can be used for predicting cannulation failure of a second ERCP procedure.
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Affiliation(s)
- Xin Deng
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
| | - Rui Liao
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
| | - Long Pan
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
| | - Chengyou Du
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
| | - Qiao Wu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
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Jawaid S, Draganov PV, Aihara H, Khashab MA, Yang D. Pilot prospective study on formal training in per-oral endoscopic myotomy (POEM) during advanced endoscopy fellowship. Endosc Int Open 2021; 9:E1890-E1899. [PMID: 34917458 PMCID: PMC8671003 DOI: 10.1055/a-1610-8962] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 07/31/2021] [Indexed: 11/20/2022] Open
Abstract
Background and study aims Gastroenterology societies have recently proposed core curricula for training in per-oral endoscopic myotomy (POEM) based on expert opinion with limited data on its applicability for advanced endoscopy fellowship (AEF) trainees. We prospectively evaluated the feasibility of a structured POEM training curriculum during a dedicated AEF and the trainee's performance during independent practice. Methods This was a single-center prospective study evaluating a trainee's performance of POEM using a structured assessment tool (POEMAT) to assess core cognitive and technical skills. The trainee's performance was then prospectively assessed during the first 12 months of independent practice. Results The trainee, who had not prior background in submucosal endoscopy, first observed 22 POEM cases followed by 35 hands-on procedures during his advanced endoscopy fellowship. Based on the POEMAT, submucosal entry and mucosal incision closure were the most challenging technical aspects, while cognitive skills were uniformly attained early in training. Overall, the trainee was able to cross the threshold for competence in his POEMAT performance score in 15 of his last 18 cases (83.3 %). The trainee performed 16 POEMs (baseline mean Eckardt 7.2) in his first 12 months of independent practice. Mean procedural time was 79.8 minutes (interquartile range: 67-94 minutes minutes) with no adverse events. Clinical success (Eckardt score < 3) was achieved in 100 % of the cases at a median follow-up of 20 weeks. Conclusions Results from this pilot study support the adoptability of the recently proposed core curricula for POEM training within the context of a dedicated AEF and provide a potential blueprint for future studies of performance in POEM among trainees.
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Affiliation(s)
- Salmaan Jawaid
- Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida, United States,Division of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, United States
| | - Peter V. Draganov
- Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida, United States
| | - Hiroyuki Aihara
- Division of Gastroenterology and Hepatology, Brigham and Women’s Hospital, Boston, Massachusetts, United States
| | - Mouen A. Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Medicine, Baltimore, Maryland, United States
| | - Dennis Yang
- Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida, United States
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Koo CS, Anastassiades CP, Ho KY. Changing perspectives in the training of endoscopic ultrasonography in Asia. JGH Open 2021; 5:1114-1118. [PMID: 34621995 PMCID: PMC8485406 DOI: 10.1002/jgh3.12587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 05/26/2021] [Indexed: 11/08/2022]
Abstract
Training of endoscopic ultrasound (EUS) in Asia faces challenges of the ever-increasing demand for skills to handle a growing range of both diagnostic and interventional EUS procedures, and a continual shortage of EUS training programs. To keep up with the pace of development in EUS, more short-term EUS programs have been conducted across Asia in recent years. In this aspect, the Asian EUS Group (AEG) has taken the lead to fast-track the dissemination of EUS knowledge and skills across Asia through its multinational network of training centers. AEG's programs are brought to wherever there is demand. Its versatile modular structure allows the program to be easily customized and scaled up or down to align to local needs, making it highly adaptable to the changing and varying needs in different countries. Even with the current pandemic situation, it has been able to continue its training efforts through the use of technology, including webinars, and live case demonstration.
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Affiliation(s)
- Chieh-Sian Koo
- Division of Gastroenterology and Hepatology National University Hospital Singapore
| | | | - Khek-Yu Ho
- Division of Gastroenterology and Hepatology National University Hospital Singapore
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Johnson G, Webster G, Boškoski I, Campos S, Gölder SK, Schlag C, Anderloni A, Arnelo U, Badaoui A, Bekkali N, Christodoulou D, Czakó L, Fernandez Y Viesca M, Hritz I, Hucl T, Kalaitzakis E, Kylänpää L, Nedoluzhko I, Petrone MC, Poley JW, Seicean A, Vila J, Arvanitakis M, Dinis-Ribeiro M, Ponchon T, Bisschops R. Curriculum for ERCP and endoscopic ultrasound training in Europe: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy 2021; 53:1071-1087. [PMID: 34311472 DOI: 10.1055/a-1537-8999] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The European Society of Gastrointestinal Endoscopy (ESGE) has recognized the need to formalize and enhance training in endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS). This manuscript represents the outcome of a formal Delphi process resulting in an official Position Statement of the ESGE and provides a framework to develop and maintain skills in ERCP and EUS. This curriculum is set out in terms of the prerequisites prior to training; recommended steps of training to a defined syllabus; the quality of training; and how competence should be defined and evidenced before independent practice. 1: Trainees should be competent in gastroscopy prior to commencing training. Formal training courses and the use of simulation in training are recommended. 2: Trainees should keep a contemporaneous logbook of their procedures, including key performance indicators and the degree of independence. Structured formative assessment is encouraged to enhance feedback. There should be a summative assessment process prior to commencing independent practice to ensure there is robust evidence of competence. This evidence should include a review of a trainee's procedure volume and current performance measures. A period of mentoring is strongly recommended in the early stages of independent practice. 3: Specifically for ERCP, all trainees should be competent up to Schutz level 2 complexity (management of distal biliary strictures and stones > 10 mm), with advanced ERCP requiring a further period of training. Prior to independent practice, ESGE recommends that a trainee can evidence a procedure volume of > 300 cases, a native papilla cannulation rate of ≥ 80 % (90 % after a period of mentored independent practice), complete stones clearance of ≥ 85 %, and successful stenting of distal biliary strictures of ≥ 90 % (90 % and 95 % respectively after a mentored period of independent practice). 4: The progression of EUS training and competence attainment should start from diagnostic EUS and then proceed to basic therapeutic EUS, and finally to advanced therapeutic EUS. Before independent practice, ESGE recommends that a trainee can evidence a procedure volume of > 250 cases (75 fine-needle aspirations/biopsies [FNA/FNBs]), satisfactory visualization of key anatomical landmarks in ≥ 90 % of cases, and an FNA/FNB accuracy rate of ≥ 85 %. ESGE recognizes the often inadequate quality of the evidence and the need for further studies pertaining to training in advanced endoscopy, particularly in relation to therapeutic EUS.
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Affiliation(s)
| | | | - Ivo Boškoski
- Gastroenterology and Digestive Endoscopy, Fondazione Policlinico Gemelli, Rome, Italy
| | - Sara Campos
- Gastroenterology Department, Digestive Unit, Champalimaud Foundation, Lisbon, Portugal
| | - Stefan Karl Gölder
- Department of Internal Medicine III, University Hospital Augsburg, Augsburg, Germany
| | - Christoph Schlag
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Switzerland
| | - Andrea Anderloni
- Division of Gastroenterology, Digestive Endoscopy Unit, Humanitas Clinical and Research Center-IRCCS, Rozzano, Italy
| | - Urban Arnelo
- Department of Surgical and Perioperative Sciences/Surgery, Umeå University, Umeå, Sweden
| | - Abdenor Badaoui
- Department of Gastroenterology and Hepatology, Université catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
| | - Noor Bekkali
- John Radcliffe Hospital, Oxford University Hospitals Foundation Trust, Oxford, UK
| | - Dimitrios Christodoulou
- Department of Gastroenterology, Medical School and University Hospital of Ioannina, Ioannina, Greece
| | - László Czakó
- Department of Medicine, University of Szeged, Szeged, Hungary
| | - Michael Fernandez Y Viesca
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Istvan Hritz
- Centre for Therapeutic Endoscopy, 1st Department of Surgery and Interventional Gastroenterology, Semmelweis University, Budapest, Hungary
| | - Tomas Hucl
- Department of Gastroenterology and Hepatology, IKEM, Prague, Czech Republic
| | - Evangelos Kalaitzakis
- Department of Gastroenterology, University Hospital of Heraklion, University of Crete, Heraklion, Greece.,Digestive Disease Center, University Hospital of Copenhagen/Herley, University of Copenhagen, Copenhagen, Denmark
| | - Leena Kylänpää
- Department of Gastrointestinal Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Ivan Nedoluzhko
- Moscow Clinical Scientific Center n.a. A.S. Loginov, Moscow, Russia
| | - Maria Chiara Petrone
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Milan, Italy
| | - Jan-Werner Poley
- Department of Gastroenterology & Hepatology, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Andrada Seicean
- Regional Institute of Gastroenterology and Hepatology Cluj-Napoca, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania
| | - Juan Vila
- Endoscopy Unit, Gastroenterology Department, Complejo Hospitalario de Navarra, Instituto de Investigaciones Sanitarias de Navarra (IDISNA), Pamplona, Spain
| | - Marianna Arvanitakis
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Thierry Ponchon
- Gastroenterology Division, Edouard Herriot Hospital, Lyon, France
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, and TARGID, KU Leuven, Leuven, Belgium
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Kerdsirichairat T, Shin EJ. Important Quality Metrics and Standardization in Endoscopy. Gastrointest Endosc Clin N Am 2021; 31:727-742. [PMID: 34538412 DOI: 10.1016/j.giec.2021.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Quality metrics and standardization has become critical as the Affordable Care Act mandates that the Center for Medicare and Medicaid Services change reimbursement from volume to a value-based system. While the most commonly used quality indicators are related to that of colonoscopy, quality metrics for other procedures and endoscopy units have been developed mainly by the American College of Gastroenterology and the American Society of Gastrointestinal Endoscopy. Data to show that these quality metrics, especially in the field of advanced endoscopy as well as in the era of COVID-19 pandemic, can improve patient outcomes, are anticipated.
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Affiliation(s)
- Tossapol Kerdsirichairat
- Digestive Disease Center, Bumrungrad International Hospital, Bangkok, Thailand 33 Soi Sukhumvit 3, Wattana, Bangkok 10110 Thailand
| | - Eun Ji Shin
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins Medical Institutions, 1800 Orleans Street, Sheikh Zayed Tower, Suite 7125H, Baltimore, MD 21287, USA.
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Donato G, Occhipinti P, Correale L, Spadaccini M, Repici A, Anderloni A, Fugazza A, Mosca P, Tringali A, Costamagna G, Bulajic M, de Pretis G, Gabbrielli A, Di Matteo FM, Faggiani R, Ayoubi M, De Luca L, Cantù P, Blois M, Dell’Amico I, Maurano A, Savarese MF, Manes G, Ferraro R, Barberis M, Hassan C. A prospective study on quality in endoscopic retrograde cholangiopancreatography (ERCP): trend in Italy from the REQUEST study. Endosc Int Open 2021; 9:E1563-E1571. [PMID: 34540552 PMCID: PMC8445684 DOI: 10.1055/a-1531-4691] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/07/2021] [Indexed: 12/28/2022] Open
Abstract
Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) is a complex procedure with a relatively high rate of adverse events. Data on training of operators and fulfillment of quality indicators in Italy are scarce. The goal of this study was to assess the overall quality of ERCP in Italy compared to international standards. Patients and methods This was a prospective, observational study from different Italian centers performing ERCP. Operators answered a questionnaire, then recorded data on ERCPs over a 1-to 3-month period. Results Nineteen Italian centers participated in the study. The most common concern of operators about training was the lack of structured programs. Seven/19 centers routinely used conscious sedation for ERCP. Forty-one experienced operators and 21 trainees performed 766 ERCPs: a successful deep biliary cannulation in native-papilla patients was achieved in 95.1 % of cases; the post-ERCP pancreatitis (PEP) rate was 5.4 % in native-papilla patients; cholangitis rate was 1.0 %; bleeding and perforation occurred in 2.7 % and 0.4 % of the patients, respectively. Conclusions This study revealed that, overall, ERCP is performed in the participating Italian centers meeting good quality standards, but structured training and sedation practice are still subpar. The bleeding and perforation rate slightly exceeded the American Society of Gastrointestinal Endoscopy indicator targets but they are comparable to the reported rates from other international surveys.
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Affiliation(s)
- Giulio Donato
- Gastroenterology Unit, Department of Oncological and Specialty Medicine, Ospedale “Maggiore della Carità”, Novara, Italy
| | - Pietro Occhipinti
- Gastroenterology Unit, Department of Oncological and Specialty Medicine, Ospedale “Maggiore della Carità”, Novara, Italy
| | - Loredana Correale
- Gastroenterology Unit, Department of Oncological and Specialty Medicine, Ospedale “Maggiore della Carità”, Novara, Italy
| | - Marco Spadaccini
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Hospital-IRCCS, Rozzano (MI), Italy,Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Hospital-IRCCS, Rozzano (MI), Italy; Department of Biomedical Sciences, Pieve Emanuele, Milano, Italy
| | - Alessandro Repici
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Hospital-IRCCS, Rozzano (MI), Italy,Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Hospital-IRCCS, Rozzano (MI), Italy; Department of Biomedical Sciences, Pieve Emanuele, Milano, Italy
| | - Andrea Anderloni
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Hospital-IRCCS, Rozzano (MI), Italy
| | - Alessandro Fugazza
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Hospital-IRCCS, Rozzano (MI), Italy
| | - Piergiorgio Mosca
- Division of Gastroenterology, Department of Gastroenterology & Transplantation, AOU Ospedali Riuniti, Ancona, Italy
| | - Andrea Tringali
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy,Centre for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore, Roma, Italy
| | - Guido Costamagna
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy,Centre for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore, Roma, Italy
| | - Milutin Bulajic
- Gastroenterology and GI Endoscopy Unit, University Hospital of Udine, Udine, Italy,Mater Olbia Hospital-Qatar Foundation Endowment & Gemelli Foundation, Gastroenterology and GI Endoscopy Unit, Olbia (OT), Italy
| | - Giovanni de Pretis
- Gastroenterology and Digestive Endoscopy Unit, Ospedale S. Chiara, Trento, Italy
| | | | | | - Roberto Faggiani
- Gastroenterology and Endoscopy Unit, Department of Oncological and Specialty Medicine, S. Camillo Forlanini Hospital, Rome, Italy
| | - Mohammad Ayoubi
- Gastroenterology and Endoscopy Unit, Gradenigo-Humanitas, Torino, Italy
| | - Luca De Luca
- Gastroenterology and Digestive Endoscopy Unit, A.O. Ospedale Riuniti Marche Nord, Pesaro, Italy
| | - Paolo Cantù
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Matteo Blois
- Interventional Endoscopy Unit, Azienda USL Toscana Nord-Ovest, Livorno, Italy
| | | | - Attilio Maurano
- Operative Endoscopy Unit, Azienda Ospedaliera Universitaria di Salerno, Italy
| | - Maria Flavia Savarese
- Gastroenterology and Gastrointestinal Endoscopy, General Hospital, Sanremo (IM), Italy
| | - Giampiero Manes
- Department of Gastroenterology and Digestive Endoscopy, ASST Rhodense Garbagnate Milanese, Milano, Italy
| | - Raffaella Ferraro
- Gastroenterology and Digestive Endoscopy Unit, Ospedale S. Andrea, ASL VC, Vercelli, Italy
| | - Mauro Barberis
- Gastroenterology Unit, Policlinico di Monza, Monza (MB), Italy
| | - Cesare Hassan
- Department of Gastroenterology, Nuovo Regina Margherita Hospital, Roma, Italy
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Chung MJ, Park SW, Kim SH, Cho CM, Choi JH, Choi EK, Lee TH, Cho E, Lee JK, Song TJ, Lee JM, Son JH, Park JS, Oh CH, Park DA, Byeon JS, Lee ST, Kim HG, Chun HJ, Choi HS, Park CG, Cho JY. [Clinical and Technical Guideline for Endoscopic Ultrasound-guided Tissue Acquisition of Pancreatic Solid Tumor: Korean Society of Gastrointestinal Endoscopy]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2021; 78:73-93. [PMID: 34446631 DOI: 10.4166/kjg.2021.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 04/30/2021] [Accepted: 05/05/2021] [Indexed: 12/13/2022]
Abstract
Endoscopic ultrasound (EUS)-guided tissue acquisition of pancreatic solid tumor requires a strict recommendation for its proper use in clinical practice because of its technical difficulty and invasiveness. The Korean Society of Gastrointestinal Endoscopy appointed a Task Force to draft clinical practice guidelines for EUS-guided tissue acquisition of pancreatic solid tumor. The strength of recommendation and the level of evidence for each statement were graded according to the Minds Handbook for Clinical Practice Guideline Development 2014. The committee, comprising a development panel of 16 endosonographers and an expert on guideline development methodology, developed 12 evidence-based recommendations in eight categories intended to help physicians make evidence- based clinical judgments with regard to the diagnosis of pancreatic solid tumor. This clinical practice guideline discusses EUS-guided sampling in pancreatic solid tumor and makes recommendations on circumstances that warrant its use, technical issues related to maximizing the diagnostic yield (e.g., needle type, needle diameter, adequate number of needle passes, sample obtaining techniques, and methods of specimen processing), adverse events of EUS-guided tissue acquisition, and learning-related issues. This guideline was reviewed by external experts and suggests best practices recommended based on the evidence available at the time of preparation. This guideline may not be applicable for all clinical situations and should be interpreted in light of specific situations and the availability of resources. It will be revised as necessary to cover progress and changes in technology and evidence from clinical practice.
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Affiliation(s)
- Moon Jae Chung
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Se Woo Park
- Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwasung, Korea
| | - Seong-Hun Kim
- Department of Internal Medicine, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Korea
| | - Chang Min Cho
- Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jun-Ho Choi
- Department of Internal Medicine, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea
| | - Eun Kwang Choi
- Department of Internal Medicine, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Korea
| | - Tae Hoon Lee
- Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Eunae Cho
- Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Jun Kyu Lee
- Department of Internal Medicine, Dongguk University Medical Center, Dongguk University College of Medicine, Goyang, Korea
| | - Tae Jun Song
- Department of Internal Medicine, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
| | - Jae Min Lee
- Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jun Hyuk Son
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Jin Suk Park
- Department of Internal Medicine, Inha University Hospital, Inha University College of Medicine,Incheon, Korea
| | - Chi Hyuk Oh
- Department of Internal Medicine, KyungHee University Medical Center, Kyung Hee University College of Medicine, Seoul, Korea
| | - Dong-Ah Park
- Division of Healthcare Technology Assessment Research, Office of Health Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Jeong-Sik Byeon
- Department of Internal Medicine, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
| | - Soo Teik Lee
- Department of Internal Medicine, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Korea
| | - Ho Gak Kim
- Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Hoon Jai Chun
- Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Ho Soon Choi
- Department of Internal Medicine, Hanyang University Medical Center, Hanyang University College of Medicine, Seoul, Korea
| | - Chan Guk Park
- Department of Internal Medicine, Chosun University Hospital, Chosun University College of Medicine, Gwangju, Korea
| | - Joo Young Cho
- Department of Internal Medicine, Cha University Bundang Medical Center, Cha University, Seongnam, Korea
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Learning Curve for CT-Guided Percutaneous Transthoracic Core Needle Biopsy: Retrospective Evaluation Among 17 Thoracic Imaging Fellows at a Tertiary Referral Hospital. AJR Am J Roentgenol 2021; 218:112-123. [PMID: 34406052 DOI: 10.2214/ajr.21.26346] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
To listen to the podcast associated with this article, please select one of the following: iTunes, Google Play, or direct download. Background: CT-guided percutaneous transthoracic needle biopsy (PTNB) is widely used for evaluation of indeterminate pulmonary lesions, though guidelines are lacking regarding the experience needed to gain sufficient skill. Objective: To investigate the learning curve among a large number of operators in a tertiary referral hospital and to determine the number of procedures required to obtain acceptable performance. Methods: This retrospective study included CT-guided PTNBs with coaxial technique performed by 17 thoracic imaging fellows from March 2011 to August 2017 who were novices in the procedure. A maximum of 200 consecutive procedures per operator were included. Cumulative summation method was used to assess learning curves for diagnostic accuracy, false negative rate, pneumothorax rate, and hemoptysis rate. Operators were assessed individually and in a pooled analysis. Pneumothorax risk was also assessed in a model adjusting for risk factors. Acceptable failure rates were defined as 0.1 for diagnostic accuracy and false negative rate; 0.45 for pneumothorax rate; and 0.05 for hemoptysis rate. Results: The study included 3261 procedures in 3134 patients (mean age, 67.7±12.1 years; 1876 men, 1258 women). Overall diagnostic accuracy was 94.2% (2960/3141). All 17 operators achieved acceptable diagnostic accuracy [37 procedures required in pooled analysis; median of 33 procedures (range 19-67) required]. Overall false negative rate was 7.6% (179/2370). All 17 operators achieved acceptable false negative rate [52 procedures required in pooled analysis; median of 33 procedures (range 19-95) required]. Pneumothorax occurred in 32.6% (1063/3261), and hemoptysis in 2.7% (89/3261). All 17 operators achieved acceptable pneumothorax rate [20 procedures required in pooled analysis; median of 19 procedures (range 7-63) required]. In the risk-adjusted model, 15 operators achieved acceptable pneumothorax rate [54 procedures required in pooled analysis; median of 36 procedures (range 10-192) required]. Sixteen operators achieved acceptable hemoptysis rate [67 procedures required in pooled analysis; median of 55 procedures (range 41-152) required]. Conclusion: For CT-guided PTNB, at least 37 and 52 procedures are required to achieve acceptable diagnostic accuracy and false negative rate, respectively. Not all operators achieved acceptable complication rates. Clinical Impact: The findings may help set standards for training, supervision, and ongoing assessment of proficiency for this procedure.
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Forbes N, Leontiadis GI, Vaska M, Elmunzer BJ, Yuan Y, Bishay K, Meng ZW, Iannuzzi J, O'Sullivan DE, Mah B, Partridge ACR, Henderson AM, Qureshi A, Keswani RN, Wani S, Bridges RJ, Heitman SJ, Hilsden RJ, Ruan Y, Brenner DR. Adverse events associated with endoscopic retrograde cholangiopancreatography: protocol for a systematic review and meta-analysis. BMJ Open 2021; 11:e053302. [PMID: 34404717 PMCID: PMC8372880 DOI: 10.1136/bmjopen-2021-053302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/28/2021] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Endoscopic retrograde cholangiopancreatography (ERCP) is performed to diagnose and manage conditions of the biliary and pancreatic ducts. Though effective, it is associated with common adverse events (AEs). The purpose of this study is to systematically review ERCP AE rates and report up-to-date pooled estimates. METHODS AND ANALYSIS A comprehensive electronic search will be conducted of relevant medical databases through 10 November 2020. A study team of eight data abstracters will independently determine study eligibility, assess quality and abstract data in parallel, with any two concordant entries constituting agreement and with discrepancies resolved by consensus. The primary outcome will be the pooled incidence of post-ERCP pancreatitis, with secondary outcomes including post-ERCP bleeding, cholangitis, perforation, cholecystitis, death and unplanned healthcare encounters. Secondary outcomes will also include rates of specific and overall AEs within clinically relevant subgroups determined a priori. DerSimonian and Laird random effects models will be used to perform meta-analyses of these outcomes. Sources of heterogeneity will be explored via meta-regression. Subgroup analyses based on median dates of data collection across studies will be performed to determine whether AE rates have changed over time. ETHICS AND DISSEMINATION Ethics approval is not required for this study as it is a planned meta-analysis of previously published data. Participant consent is similarly not required. Dissemination is planned via presentation at relevant conferences in addition to publication in peer-reviewed journals.PROSPERO registration numberCRD42020220221.
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Affiliation(s)
- Nauzer Forbes
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Grigorios I Leontiadis
- Department of Medicine, Division of Gastroenterology, McMaster University, Hamilton, Ontario, Canada
- Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Marcus Vaska
- Knowledge Resource Service, Alberta Health Services, Calgary, Alberta, Canada
| | - B Joseph Elmunzer
- Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Yuhong Yuan
- Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Kirles Bishay
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Zhao Wu Meng
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Jordan Iannuzzi
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
| | - Dylan E O'Sullivan
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Brittany Mah
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Arun C R Partridge
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
| | - Amanda M Henderson
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
| | - Aatif Qureshi
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
| | - Rajesh N Keswani
- Division of Gastroenterology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Sachin Wani
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Ronald J Bridges
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
| | - Steven J Heitman
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Robert J Hilsden
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Yibing Ruan
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Cancer Epidemiology and Prevention Research, Cancer Control Alberta, Alberta Health Services, Calgary, Alberta, Canada
| | - Darren R Brenner
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Cancer Epidemiology and Prevention Research, Cancer Control Alberta, Alberta Health Services, Calgary, Alberta, Canada
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Fung BM, Pitea TC, Tabibian JH. Difficult Biliary Cannulation in Endoscopic Retrograde Cholangiopancreatography: Definitions, Risk Factors, and Implications. EUROPEAN MEDICAL JOURNAL. HEPATOLOGY 2021; 9:64-72. [PMID: 34621527 PMCID: PMC8494185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Over the past 50 years, endoscopic retrograde cholangiopancreatography (ERCP) has become the preferred minimally invasive method of treating a vast array of pancreatobiliary diseases. An initial sine qua non for ERCP success is selective ductal cannulation. Despite significant progress in the optimisation of ERCP methods and accessories, selective biliary cannulation using conventional techniques remains unsuccessful in approximately 15% of native papilla cases. Furthermore, difficult biliary cannulation has been associated with an increased risk of post-ERCP pancreatitis, among other adverse events. Here, in the first of a two-part series, the authors provide a primer on standard biliary cannulation techniques and discuss the definition, risk factors, and implications of difficult biliary cannulation. The second part of the series will provide an overview of the existing advanced techniques used in cases of difficult biliary cannulation as well as the approach to their selection.
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Affiliation(s)
- Brian M. Fung
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Arizona College of Medicine – Phoenix, Arizona, USA
- Banner – University Medical Center Phoenix, Arizona, USA
| | | | - James H. Tabibian
- Division of Gastroenterology, Department of Medicine, Olive View-UCLA Medical Center, Sylmar, California, USA
- Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Dhir V, Udawat P, Shah R, Alahari A. Feasibility of an EUS e-training course with live cases. Endosc Int Open 2021; 9:E1291-E1296. [PMID: 34447878 PMCID: PMC8383075 DOI: 10.1055/a-1482-8303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 03/22/2021] [Indexed: 11/23/2022] Open
Abstract
Background and study aims One-on-one endoscopic ultrasound (EUS) mentorship was not possible at most institutions during the COVID-19 pandemic. We decided to test the feasibility of structured training in EUS with virtual e-classes with live cases. The aim of this study was to assess the feasibility of a virtual EUS training course with objective end points. Patients and methods Twenty-one trainees were trained on a virtual platform over 16 classes of 90 minutes each, over 3 months. The virtual training screen had two equal parts, one showing the endoscopist's hand movements, and another the resultant EUS display. The course curriculum included EUS anatomy of the mediastinum, pancreatico-biliary region and rectum. The assessment was done on videos of procedures performed by trainees. Results Twenty trainees performed 251 EUS procedures (range 8-25, mean 12.5 ± 4.9) at their institutions. At the end of the course, all students (100 %) could maneuver the echo-endoscope through to the duodenum. Fifteen trainees sent a video for final assessment. The successful specified area identification rates were 12 of 15 (80 %) for the subcarinal space, 10 of15 (66.6 %) for the head of the pancreas, 10 of 15 (66.6 %) for the common bile duct, and nine of 15 (60 %) for the tail of pancreas. The success rate of ability to get appropriate windows was 10 of 15 (67 %) for the subcarinal space, eight of 15 (53.3 %) for the head of the pancreas, seven of 15 (46.6 %) for the common bile duct and six of 15 (40 %) for the tail of pancreas. No adverse events were reported. Conclusions A virtual EUS training course with live cases appears feasible. It allows the possibility of training a large number of students. Further evaluation is needed, especially of virtual assessment methods and training benchmarks.
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Affiliation(s)
- Vinay Dhir
- Institute of Digestive and Liver Care, Sl Raheja Hospital – School of EUS, Mumbai, India
| | - Priyanka Udawat
- Institute of Digestive and Liver Care, Sl Raheja Hospital – School of EUS, Mumbai, India
| | - Rahul Shah
- Institute of Digestive and Liver Care, Sl Raheja Hospital – School of EUS, Mumbai, India
| | - Aruna Alahari
- Institute of Digestive and Liver Care, Sl Raheja Hospital – School of EUS, Mumbai, India
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