449 Variation in Learning Curves and Competence for Endoscopic Retrograde Cholangiopancreatography Among Advanced Endoscopy Trainees (AETs) Using Cumlative Sum Analysis (CUSUM)- Implication for American Scoiety for Gastrointestinal Endoscopy Society for Gastrointestinal Endoscopy Recommendations for Training

2015 ◽  
Vol 81 (5) ◽  
pp. AB150
Author(s):  
Sachin Wani ◽  
Andrew Y. Wang ◽  
Christopher J. Dimaio ◽  
V. Raman Muthusamy ◽  
Rajesh N. Keswani ◽  
...  
2011 ◽  
Vol 152 (26) ◽  
pp. 1043-1051 ◽  
Author(s):  
András Taller

There are only few data of gastrointestinal endoscopy in pregnant patients. Only 0.4% of all procedures are carried out during pregnancy. Case reports and some small retrospective studies are available. Because of physiological changes in pregnancy there might be special risks of endoscopy. There might be complaints which can be physiologic during pregnancy, but can be signs of gastrointestinal disorders, too. Therefore, indications for endoscopy are not always clear and easy. Safety of the procedures is also not well studied. Besides the risks of endoscopy, medication given to the mother, electrocoagulation and radiation exposure from fluoroscopy during endoscopic retrograde cholangiopancreatography might be harmful to the fetus. Endoscopy should only be done when indication is unquestionable and strong. Only FDA „A” and „B” category medication is allowed. Gastroscopy is necessary for bleeding and for patients with pyrosis going together with alarm signs. Nausea, vomiting, abdominal pain and fecal occult blood test positivity are not indications for endoscopy, only for gastroenterogical consultation. Sigmoidoscopy is recommended for indication of lower gastrointestinal bleeding and sigmoid or rectal mass. Only therapeutic endoscopic retrograde cholangiopancreatography should be performed. Obstructive jaundice and biliary pancreatitis need immediate endoscopic intervention. The fetus must be shielded from radiation exposure. Orv. Hetil., 2011, 152, 1043–1051.


Author(s):  
Saleh A. Alghsoon ◽  
Khaled S. Shaban ◽  
Altaf H. Khan ◽  
Fares M. Almeshal ◽  
Sulaimon O. Balogun ◽  
...  

ABSTRACT Introduction Endoscopic retrograde cholangiopancreatography (ERCP) is a relatively new endoscopic procedure combined with fluoroscopy that is performed for multiple diagnostic and therapeutic indications. It carries a known risk of radiation exposure to patients and staff. We aimed to examine radiation administration techniques and to measure the radiation dose delivered by these techniques. Methods This was a retrospective analysis of 437 ERCP procedures performed at a tertiary care hospital between April 2015 and April 2017. Results A total of 437 ERCP procedural charts were reviewed: fluoroscopy administration was endoscopist controlled (EC, n = 187, 42.79%) or technician controlled (TC, n = 250, 57.21%). The mean (and SD) fluoroscopy time (FT) was 2.107 ± 2.0 minutes. The mean (and SD) dose–area product (DAP) was 15,227.371 ± 16,784.738 Gy·cm2. The degree of ERCP difficulty was evaluated as recommended by the American Society for Gastrointestinal Endoscopy, and graded 1–4. Level I TC procedures had a mean FT and DAP of 1.600 minutes and 12,644.72 Gy·cm2, respectively. The FT and DAP values for level I EC procedures were 1.514 minutes and 12,966.71 Gy·cm2, respectively, as compared with level IV TC procedures (mean FT, 2.539 minutes; mean DAP, 19,469.94 Gy·cm2) and level IV EC procedures (mean FT, 4.890 minutes; mean DAP, 37,921.00 Gy·cm2). Conclusion DAP and FT are increased significantly in EC ERCP in American Society for Gastrointestinal Endoscopy 4 procedures. Comparison of the different degrees of difficulty indicated that there is a linear correlation between the degree of difficulty and both FT and DAP.


2021 ◽  
Vol 96 (4) ◽  
pp. 318-327
Author(s):  
Young Jung Kim ◽  
Chang Hwan Park

Endoscopic retrograde cholangiopancreatography (ERCP)-related iatrogenic perforations are identified when gas or luminal contents exit the gastrointestinal tract during ERCP. Although perforations are rare, mortality is high; prompt diagnosis and appropriate management are essential. A multidisciplinary approach is required. The vast majority of such patients can be safely managed medically and endoscopically but must be carefully selected. Endoscopic closure can be considered, depending on the type of perforation. In patients who are deteriorating or whose iatrogenic perforations are not securely closed endoscopically, surgery is mandatory.


2020 ◽  
Vol 3 (Supplement_1) ◽  
pp. 149-150
Author(s):  
U Khan ◽  
A N Barkun ◽  
E I Benchimol ◽  
M Salim ◽  
J J Telford ◽  
...  

Abstract Background Previous studies have demonstrated that many graduating trainees may not have all of the skills needed to independently practice endoscopic retrograde cholangiopancreatography (ERCP) safely and effectively. As a part of competency-based learning curriculum development, it is essential to provide formative feedback to trainees and ensure they acquire the knowledge and skills for independent practice. Aims To assess the performance of advanced endoscopy trainees across Canada using the Canadian Direct Observation of Procedural Skills (CanDOPS) ERCP assessment tool. Procedural items evaluated include both technical (cannulation, sphincterotomy, stone extraction, tissue sampling, and stent placement) and non-technical (leadership, communication and teamwork, judgment and decision making) skills. Methods We conducted a prospective national multi-centre prospective study. Advanced endoscopy trainees with at least two years of gastroenterology training or five years of general surgery in North America and minimal experience performing ERCPs (less than 100 ERCP procedures) were invited to participate. The CanDOPS tool was used to measure every fifth ERCP performed by trainees over a 12-month fellowship training period. ERCPs were evaluated by experienced staff endoscopists at each study site under standard clinical protocol. Cumulative sum (CUSUM) analyses were used to generate learning curves. Results The data from five Canadian sites and 11 trainees participated in the study. A total of 261ERCP evaluations were completed. Median number of evaluations by site and trainee was 49 (IQR 31–76) and 15 (IQR 11–45). Median number of cases trainees performed prior to their ERCP training was 50 (IQR 25–400). There was a significant improvement in almost all scores over time, including selective cannulation, sphincterotomy, biliary stenting and all non-technical skills (P<0.01). CUSUM analyses using acceptable and unacceptable failure rates of 20% and 50% demonstrated trainees achieved competency for most measures in their final month of their training. Competency in tissue sampling was not achieved within a one-year training period. Conclusions This is the first ERCP performance evaluation tool that examines multiple technical and non-technical aspects of the procedure. Although trainee ERCP skills do improve during their training period, there exists a notable variability in time to competency for the different skills measured using the CanDOPS tool. Large prospective research is required to determine if competency is achieved using more stringent definitions of ERCP competency and to determine factors associated with reaching competency. Funding Agencies None


Endoscopy ◽  
2020 ◽  
Author(s):  
Marten A. Lantinga ◽  
Felix Theunissen ◽  
Pieter C. J. ter Borg ◽  
Marco J. Bruno ◽  
Rob J. T. Ouwendijk ◽  
...  

Abstract Background COVID-19 has dramatically affected gastrointestinal endoscopy practice. We aimed to investigate its impact on procedure types, indications, and findings. Methods We retrospectively analyzed endoscopies performed in 15 Dutch hospitals by comparing periods 15 March to 25 June of 2019 and 2020 using the prospective Trans.IT database. Results During lockdown in 2020, 9776 patients underwent endoscopy compared with 19 296 in 2019. Gastroscopies decreased by 57 % (from 7846 to 4467) and colonoscopies by 45 % (from 12219 to 5609), whereas endoscopic retrograde cholangiopancreatography volumes remained comparable (from 578 to 522). Although endoscopy results indicative of cancer decreased (from 524 to 340), the likelihood of detecting cancer during endoscopy increased (2.7 % [95 % confidence interval (CI) 2.5 – 3.0] in 2019 versus 3.5 % [95 %CI 3.1 – 3.9] in 2020; P < 0.001). After lifting of lockdown, endoscopy volumes started to return to normal, except for colorectal cancer screening. Conclusions Fewer endoscopies were performed during the COVID-19 lockdown, leading to a significant reduction in the absolute detection of cancer. Endoscopies increased rapidly after lockdown, except for colorectal cancer screening.


Sign in / Sign up

Export Citation Format

Share Document