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Antonelli G, Voiosu AM, Pawlak KM, Gonçalves TC, Le N, Bronswijk M, Hollenbach M, Elshaarawy O, Beilenhoff U, Mascagni P, Voiosu T, Pellisé M, Dinis-Ribeiro M, Triantafyllou K, Arvanitakis M, Bisschops R, Hassan C, Messmann H, Gralnek IM. Training in basic gastrointestinal endoscopic procedures: a European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) Position Statement. Endoscopy 2024; 56:131-150. [PMID: 38040025 DOI: 10.1055/a-2205-2613] [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: 12/03/2023]
Abstract
This ESGE Position Statement provides structured and evidence-based guidance on the essential requirements and processes involved in training in basic gastrointestinal (GI) endoscopic procedures. The document outlines definitions; competencies required, and means to their assessment and maintenance; the structure and requirements of training programs; patient safety and medicolegal issues. 1: ESGE and ESGENA define basic endoscopic procedures as those procedures that are commonly indicated, generally accessible, and expected to be mastered (technically and cognitively) by the end of any core training program in gastrointestinal endoscopy. 2: ESGE and ESGENA consider the following as basic endoscopic procedures: diagnostic upper and lower GI endoscopy, as well as a limited range of interventions such as: tissue acquisition via cold biopsy forceps, polypectomy for lesions ≤ 10 mm, hemostasis techniques, enteral feeding tube placement, foreign body retrieval, dilation of simple esophageal strictures, and India ink tattooing of lesion location. 3: ESGE and ESGENA recommend that training in GI endoscopy should be subject to stringent formal requirements that ensure all ESGE key performance indicators (KPIs) are met. 4: Training in basic endoscopic procedures is a complex process and includes the development and acquisition of cognitive, technical/motor, and integrative skills. Therefore, ESGE and ESGENA recommend the use of validated tools to track the development of skills and assess competence. 5: ESGE and ESGENA recommend incorporating a multimodal approach to evaluating competence in basic GI endoscopic procedures, including procedural thresholds and the measurement and documentation of established ESGE KPIs. 7: ESGE and ESGENA recommend the continuous monitoring of ESGE KPIs during GI endoscopy training to ensure the trainee's maintenance of competence. 9: ESGE and ESGENA recommend that GI endoscopy training units fulfil the ESGE KPIs for endoscopy units and, furthermore, be capable of providing the dedicated personnel, infrastructure, and sufficient case volume required for successful training within a structured training program. 10: ESGE and ESGENA recommend that trainers in basic GI endoscopic procedures should be endoscopists with formal educational training in the teaching of endoscopy, which allows them to successfully and safely teach trainees.
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Affiliation(s)
- Giulio Antonelli
- Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, "Sapienza" University of Rome, Italy
- Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli Hospital, Ariccia, Rome, Italy
| | - Andrei M Voiosu
- Department of Gastroenterology, Colentina Clinical Hospital, Bucharest, Romania
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Katarzyna M Pawlak
- Endoscopy Unit, Gastroenterology Department, Hospital of the Ministry of Interior and Administration, Szczecin, Poland
- The Center for Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - Tiago Cúrdia Gonçalves
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
| | - Nha Le
- Gastroenterology Division, Internal Medicine and Hematology Department, Semmelweis University, Budapest, Hungary
| | - Michiel Bronswijk
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Belgium
- Department of Gastroenterology and Hepatology, Imelda General Hospital, Bonheiden, Belgium
| | - Marcus Hollenbach
- Division of Gastroenterology, Medical Department II, University of Leipzig Medical Center, Leipzig, Germany
| | - Omar Elshaarawy
- Hepatology and Gastroenterology Department, National Liver Institute, Menoufia University, Menoufia, Egypt
| | | | - Pietro Mascagni
- IHU Strasbourg, Strasbourg, France
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Theodor Voiosu
- Department of Gastroenterology, Colentina Clinical Hospital, Bucharest, Romania
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Maria Pellisé
- Department of Gastroenterology, Hospital Clínic Barcelona, Barcelona, Spain
| | - Mário Dinis-Ribeiro
- Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal
- MEDCIDS/Faculty of Medicine, University of Porto, Porto, Portugal
| | | | - Marianna Arvanitakis
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, TARGID, Leuven, Belgium
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, TARGID, Leuven, Belgium
| | - Cesare Hassan
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Endoscopy Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Helmut Messmann
- Department of Gastroenterology, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Ian M Gralnek
- Institute of Gastroenterology and Hepatology, Emek Medical Center, Afula, Israel
- Rappaport Faculty of Medicine Technion Israel Institute of Technology, Haifa, Israel
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Sabrie N, Khan R, Seleq S, Homsi H, Gimpaya N, Bansal R, Scaffidi MA, Lightfoot D, Grover SC. Global trends in training and credentialing guidelines for gastrointestinal endoscopy: a systematic review. Endosc Int Open 2023; 11:E193-E201. [PMID: 36845269 PMCID: PMC9949985 DOI: 10.1055/a-1981-3047] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 11/16/2022] [Indexed: 11/19/2022] Open
Abstract
Background and study aims Credentialing, the process through which an institution assesses and validates an endoscopist's qualifications to independently perform a procedure, can vary by region and country. Little is known about these inter-societal and geographic differences. We aimed to systematically characterize credentialing recommendations and requirements worldwide. Methods We conducted a systematic review of credentialing practices among gastrointestinal and endoscopy societies worldwide. An electronic search as well as hand-search of World Endoscopy Organization members' websites was performed for credentialing documents. Abstracts were screened in duplicate and independently. Data were collected on procedures included in each document (e. g. colonoscopy, ERCP) and types of credentialing statements (procedural volume, key performance indicators (KPIs), and competency assessments). The primary objective was to qualitatively describe and compare the available credentialing recommendations and requirements from the included studies. Descriptive statistics were used to summarize data when appropriate. Results We screened 653 records and included 20 credentialing documents from 12 societies. Guidelines most commonly included credentialing statements for colonoscopy, esophagogastroduodenoscopy (EGD), and ERCP. For colonoscopy, minimum procedural volumes ranged from 150 to 275 and adenoma detection rate (ADR) from 20 % to 30%. For EGD, minimum procedural volumes ranged from 130 to 1000, and duodenal intubation rate of 95 % to 100%. For ERCP, minimum procedural volumes ranged from 100 to 300 with selective duct cannulation success rate of 80 % to 90 %. Guidelines also reported on flexible sigmoidoscopy, capsule endoscopy, and endoscopic ultrasound. Conclusions While some metrics such as ADR were relatively consistent among societies, there was substantial variation among societies with respect to procedural volume and KPI statements.
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Affiliation(s)
| | - Rishad Khan
- Department of Medicine, University of Toronto, Toronto, Canada,Division of Gastroenterology, St. Michael’s Hospital, Toronto, Canada
| | - Samir Seleq
- Division of Gastroenterology, St. Michael’s Hospital, Toronto, Canada
| | - Hoomam Homsi
- Division of Gastroenterology, St. Michael’s Hospital, Toronto, Canada
| | - Nikko Gimpaya
- Division of Gastroenterology, St. Michael’s Hospital, Toronto, Canada
| | - Rishi Bansal
- Division of Gastroenterology, St. Michael’s Hospital, Toronto, Canada
| | | | - David Lightfoot
- Division of Gastroenterology, St. Michael’s Hospital, Toronto, Canada
| | - Samir C. Grover
- Department of Medicine, University of Toronto, Toronto, Canada,Division of Gastroenterology, St. Michael’s Hospital, Toronto, Canada,The Centre for Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, Toronto, Canada,Li Ka Shing Knowledge Institute, Toronto, Canada
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Low DJ, Hong Z, Khan R, Bansal R, Gimpaya N, Grover SC. Automated detection of cecal intubation with variable bowel preparation using a deep convolutional neural network. Endosc Int Open 2021; 9:E1778-E1784. [PMID: 34790545 PMCID: PMC8589561 DOI: 10.1055/a-1546-8266] [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: 02/05/2021] [Accepted: 06/04/2021] [Indexed: 12/15/2022] Open
Abstract
Background and study aims Colonoscopy completion reduces post-colonoscopy colorectal cancer. As a result, there have been attempts at implementing artificial intelligence to automate the detection of the appendiceal orifice (AO) for quality assurance. However, the utilization of these algorithms has not been demonstrated in suboptimal conditions, including variable bowel preparation. We present an automated computer-assisted method using a deep convolutional neural network to detect the AO irrespective of bowel preparation. Methods A total of 13,222 images (6,663 AO and 1,322 non-AO) were extracted from 35 colonoscopy videos recorded between 2015 and 2018. The images were labelled with Boston Bowel Preparation Scale scores. A total of 11,900 images were used for training/validation and 1,322 for testing. We developed a convolutional neural network (CNN) with a DenseNet architecture pre-trained on ImageNet as a feature extractor on our data and trained a classifier uniquely tailored for identification of AO and non-AO images using binary cross entropy loss. Results The deep convolutional neural network was able to correctly classify the AO and non-AO images with an accuracy of 94 %. The area under the receiver operating curve of this neural network was 0.98. The sensitivity, specificity, positive predictive value, and negative predictive value of the algorithm were 0.96, 0.92, 0.92 and 0.96, respectively. AO detection was > 95 % regardless of BBPS scores, while non-AO detection improved from BBPS 1 score (83.95 %) to BBPS 3 score (98.28 %). Conclusions A deep convolutional neural network was created demonstrating excellent discrimination between AO from non-AO images despite variable bowel preparation. This algorithm will require further testing to ascertain its effectiveness in real-time colonoscopy.
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Affiliation(s)
| | | | - Rishad Khan
- St. Michael’s Hospital, University of Toronto
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Sugimoto K, Osawa S. 'Four-position method' makes beginner endoscopists aware of spatial positioning of the left hand to master upper gastrointestinal endoscopy. Endosc Int Open 2020; 8:E1225-E1230. [PMID: 33015323 PMCID: PMC7505699 DOI: 10.1055/a-1197-6418] [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: 02/23/2020] [Accepted: 05/19/2020] [Indexed: 11/25/2022] Open
Abstract
Background and study aims We developed a novel "four-position method" for facilitating endoscopy of the upper gastrointestinal tract, and this study aimed to verify its usefulness for beginner endoscopists. Methods Medical students (n = 121) were divided into three groups. A simulator subsequently was used to perform endoscopy. Group A was taught how to hold the endoscope and move the dial; Group B was taught the "four-position method"; and Group C, in addition to being taught the "four-position method," was permitted to use an endoscope before introduction to the simulator. In each group, the transit time to various parts of the upper digestive tract was recorded in addition to the time to grasp a clip in the stomach with the forceps. We also surveyed the groups with respect to their impression of the difficulty level of endoscopic operation before and after instructions. Results Transit time to the cardia was no different among the groups; however, with regard to other targets, Group C reached the sites significantly more quickly than did Groups A and B. Time to clip grasping was significantly shorter in Groups B and C than in Group A. Regarding the impression of the difficulty level, significantly more students in Groups B and C compared to Group A felt that endoscopy was easier after instructions. Conclusion Learning the "four-position method" made it possible to achieve stable endoscopic manipulation at an early stage and improve subsequent endoscopic procedures.
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Affiliation(s)
- Ken Sugimoto
- First Department of Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Satoshi Osawa
- Department of Endoscopic and Photodynamic Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
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Januszewicz W, Kaminski MF. Quality indicators in diagnostic upper gastrointestinal endoscopy. Therap Adv Gastroenterol 2020; 13:1756284820916693. [PMID: 32477426 PMCID: PMC7232050 DOI: 10.1177/1756284820916693] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 03/06/2020] [Indexed: 02/04/2023] Open
Abstract
Upper gastrointestinal (UGI) endoscopy contributes a major clinical service with consistently growing demand around the world. Its utility corresponds to varying epidemiological issues throughout the globe, with cancer screening and surveillance being of the utmost priority. Despite high accuracy in neoplasia detection, UGI endoscopy remains a highly operator-dependent procedure, characterized by a substantial rate of missed pathology. Despite an overall lack of high-quality performance measures, there is an increased level of awareness about the need for quality control of this procedure, which is reflected in several guidelines and position statements published in recent years. It is widely recognized that quality assessment should go beyond mere technical aspects of the examination, and include both pre- and post-procedural factors. By this means, quality control encompasses the entire patient experience with the health care provider, from appropriate indication and physical assessment, through high-quality endoscopy service, to appropriate follow up and patient satisfaction. This article aims to review the available and emerging quality metrics for UGI endoscopy, taken mostly from Western endoscopy societies, with references to Asian recommendations where appropriate. The paper is limited solely to diagnostic UGI endoscopy and does not include performance measures for therapeutic procedures.
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Affiliation(s)
| | - Michal F. Kaminski
- Department of Gastroenterological Oncology, the
Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology,
Warsaw, Poland,Department of Gastroenterology, Hepatology and
Clinical Oncology, Center of Postgraduate Medical Education, Warsaw,
Poland,Department of Cancer Prevention, the Maria
Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw,
Poland,Institute of Health and Society, University of
Oslo, Oslo, Norway
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Ward ST, Hancox A, Mohammed MA, Ismail T, Griffiths EA, Valori R, Dunckley P. The learning curve to achieve satisfactory completion rates in upper GI endoscopy: an analysis of a national training database. Gut 2017; 66:1022-1033. [PMID: 26976733 DOI: 10.1136/gutjnl-2015-310443] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 02/19/2016] [Accepted: 02/25/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The aim of this study was to determine the number of OGDs (oesophago-gastro-duodenoscopies) trainees need to perform to acquire competency in terms of successful unassisted completion to the second part of the duodenum 95% of the time. DESIGN OGD data were retrieved from the trainee e-portfolio developed by the Joint Advisory Group on GI Endoscopy (JAG) in the UK. All trainees were included unless they were known to have a baseline experience of >20 procedures or had submitted data for <20 procedures. The primary outcome measure was OGD completion, defined as passage of the endoscope to the second part of the duodenum without physical assistance. The number of OGDs required to achieve a 95% completion rate was calculated by the moving average method and learning curve cumulative summation (LC-Cusum) analysis. To determine which factors were independently associated with OGD completion, a mixed effects logistic regression model was constructed with OGD completion as the outcome variable. RESULTS Data were analysed for 1255 trainees over 288 centres, representing 243 555 OGDs. By moving average method, trainees attained a 95% completion rate at 187 procedures. By LC-Cusum analysis, after 200 procedures, >90% trainees had attained a 95% completion rate. Total number of OGDs performed, trainee age and experience in lower GI endoscopy were factors independently associated with OGD completion. CONCLUSIONS There are limited published data on the OGD learning curve. This is the largest study to date analysing the learning curve for competency acquisition. The JAG competency requirement for 200 procedures appears appropriate.
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Affiliation(s)
- S T Ward
- Centre for Liver Research & NIHR Birmingham Biomedical Research Unit, Level 5 Institute for Biomedical Research, University of Birmingham, Birmingham, UK
| | - A Hancox
- Department of Surgery, Birmingham Children's Hospital, Birmingham, UK
| | - M A Mohammed
- Faculty of Health Studies, University of Bradford, Bradford, UK.,Bradford Institute for Health Research, Bradford, Yorkshire, UK.,Humberside Academic Health Sciences Network, Wakefield, UK
| | - T Ismail
- Department of Colorectal Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - E A Griffiths
- Department of Upper Gastrointestinal Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - R Valori
- Department of Gastroenterology, Gloucestershire Royal Hospital, Gloucester, UK
| | - P Dunckley
- Department of Gastroenterology, Gloucestershire Royal Hospital, Gloucester, UK
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Affiliation(s)
| | - Anand V Sahai
- Department of Gastroenterology, Centre Hospitalier de l'Universite de Montreal, Montreal, Canada
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Current status of core and advanced adult gastrointestinal endoscopy training in Canada: Survey of existing accredited programs. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2014; 27:267-72. [PMID: 23712301 DOI: 10.1155/2013/186284] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To determine the current status of core and advanced adult gastroenterology training in Canada. METHODS A survey consisting of 20 questions pertaining to core and advanced endoscopy training was circulated to 14 accredited adult gastroenterology residency program directors. For continuous variables, median and range were analyzed; for categorical variables, percentage and associated 95% CIs were analyzed. RESULTS All 14 programs responded to the survey. The median number of core trainees was six (range four to 16). The median (range) procedural volumes for gastroscopy, colonoscopy, percutaneous endoscopic gastrostomy and sigmoidoscopy, respectively, were 400 (150 to 1000), 325 (200 to 1500), 15 (zero to 250) and 60 (25 to 300). Eleven of 13 (84.6%) programs used endoscopy simulators in their curriculum. Eight of 14 programs (57%) provided a structured advanced endoscopy training fellowship. The majority (88%) offered training of combined endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasonography. The median number of positions offered yearly for advanced endoscopy fellowship was one (range one to three). The median (range) procedural volumes for ERCP, endoscopic ultrasonography and endoscopic mucosal resection, respectively, were 325 (200 to 750), 250 (80 to 400) and 20 (10 to 63). None of the current programs offered training in endoscopic submucosal dissection or natural orifice transluminal endoscopic surgery. CONCLUSION Most accredited adult Canadian gastroenterology programs met the minimal procedural requirements recommended by the Canadian Association of Gastroenterology during core training. However, a more heterogeneous experience has been observed for advanced training. Additional studies would be required to validate and standardize evaluation tools used during gastroenterology curricula.
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Gill RS, Whitlock KA, Mohamed R, Sarkhosh K, Birch DW, Karmali S. The role of upper gastrointestinal endoscopy in treating postoperative complications in bariatric surgery. JOURNAL OF INTERVENTIONAL GASTROENTEROLOGY 2012; 2:37-41. [PMID: 22586549 DOI: 10.4161/jig.20133] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Revised: 12/21/2011] [Accepted: 12/23/2011] [Indexed: 12/17/2022]
Abstract
There are an estimated 500 million obese individuals worldwide. Currently, bariatric surgery has been shown to result in clinically significant weight loss. With increasing demand for bariatric surgery, endoscopic techniques used intra and postoperatively continue to evolve. Endoscopic evaluation of anastomotic integrity following RYGB allows for early detection of anastomotic leaks. Furthermore, endoscopy is a valuable tool to diagnose and treat RYGB postoperative surgical complications such as anastomotic leakage, hemorrhage and stricture formation. Early evidence suggests that endoscopic management of upper gastrointestinal hemorrhage following RYGB is effective. In addition, endoscopic balloon dilatation is able to effectively treat obstruction in the setting of gastrojejunal anastomotic strictures. With successful endoscopic management of these complications, bariatric patients may avoid more invasive surgical procedures.
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Affiliation(s)
- Richdeep S Gill
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
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The European experience—current use of simulator training in Europe. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2011. [DOI: 10.1016/j.tgie.2011.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Abstract
OBJECTIVES We sought to conduct an assessment of the practice of gastrostomy (G) tube placement across an entire city, which would reflect usual clinical care as compared with referral center practice. METHODS We reviewed and retrospectively extracted data from patient records for all percutaneous endoscopic G (PEG) and radiological percutaneous G (RPG) tube placements at six Winnipeg hospitals between 1 April 2005 and 31 March 2007. RESULTS A total of 418 patients had G tubes (376 PEG, 42 RPG) inserted during the study period. The most common indications were cerebrovascular accidents (25%), head and neck cancer (23%), and head trauma (10%). The position of the external bolster was not documented in 38% of patients. The median time to the first complication was 10 days, initiation of feeding was 48 hours, and tube removal was 40 days. Complications developed in 102 (24%) patients. Patients with RPG tubes had more infections and were less likely to receive prophylactic antibiotics (P<0.001). In multivariate analysis, complications were more likely to occur in patients with RPG tubes and after insertions by lowest procedure volume physicians. Overall mortality was 12% within 30 days of G-tube placement. Death of one patient was directly related to peritonitis after G-tube insertion. CONCLUSIONS In usual clinical practice, there is an underuse of prophylactic antibiotics and a delay in the institution of nutritional support after G-tube placement. A small but significant proportion of patients may develop major complications, with associated risk of mortality. The higher complication rate after procedures performed by lowest volume physicians needs further evaluation.
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Bridges RJ. Report from the Canadian Association of Gastroenterology Board. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2009; 23:161-7. [PMID: 19319379 PMCID: PMC2694649 DOI: 10.1155/2009/376318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
On behalf of the Canadian Association of Gastroenterology (CAG) Board, I am pleased to provide you with this report summarizing the activities and directions of the organization on behalf of its members. It is an honour to participate in the affairs of the organization and interact with groups and individuals from across the country dedicated to advancing science and care in the field of digestive health and disease. This is a challenging time in medicine, and the organization has been working hard to enhance the benefits, programs and services available to its members. The goal is to provide the highest level of services possible to meet your needs.
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Affiliation(s)
- R J Bridges
- Canadian Association of Gastroenterology, University of Calgary, Calgary, Canada
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