Competence development in ERCP: the learning curve of novice trainees

Ekkelenkamp, Vivian E.; Koch, Arjun D.; Rauws, Erik A.; Borsboom, Gerard; Man, Robert A. de; Kuipers, Ernst J.

doi:10.1055/s-0034-1377930

Cited by 73 publications

(103 citation statements)

References 15 publications

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“…The Rotterdam Assessment Form for ERCP (RAF-E) has been shown to be a good tool to allow determination of the progress of every individual trainee with respect to different aspects of ERCP 1. The RAF-E records cannulation rates and other interventions such as stent removal or insertion.…”

Section: Training Methods For Ercp and Eusmentioning

confidence: 99%

“…The RAF-E records cannulation rates and other interventions such as stent removal or insertion. Historically, competence was merely based on ERCP numbers, but as van Ekkelenkamp et al and other studies show achieving a predefined action (eg, cannulation) is more important than procedure numbers per se 1 2 32 33. But when it comes to numbers, the Ekkelenkamp study showed successful common bile duct (CBD) cannulation in a virgin papilla of only 68% after 180 ERCPs.…”

Section: Training Methods For Ercp and Eusmentioning

confidence: 99%

“…In order to achieve competence, extensive and effective training is crucial but there is no consensus on the minimum numbers required before an individual achieves competence in either procedure, and the number to achieve competence varies between endoscopists 1 2. The American Society for Gastrointestinal Endoscopy (ASGE) has recommended a minimum of 190 supervised EUS procedures, including 75 pancreatobiliary cases and at least 25 pancreatic fine-needle aspiration (FNA) prior to certification 3.…”

Section: Introductionmentioning

confidence: 99%

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Training in ERCP and EUS in the UK anno 2017

Bekkali

Johnson

2017

Frontline Gastroenterol

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In the last 20 years, endoscopic retrograde cholangiopancreatography (ERCP) has evolved from being a diagnostic procedure to being almost exclusively therapeutic. Similarly, endoscopic ultrasound (EUS) is developing into ever-increasing therapeutic roles. Operator technique is central to diagnostic accuracy in EUS, as is effective and safer therapy for both ERCP and therapeutic EUS. Hence, effective training and robust standards for certification and revalidation are required to ensure ERCP and EUS in the UK are as effective and as safe as possible.

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Section: Training Methods For Ercp and Eusmentioning

confidence: 99%

Section: Training Methods For Ercp and Eusmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Training in ERCP and EUS in the UK anno 2017

Bekkali

Johnson

2017

Frontline Gastroenterol

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“…Current research supports establishing a standard of 80-90% technical success before trainees are deemed competent in a specific skill [9]. Nevertheless, individual trainees may differ in the acquisition of technical skills.…”

Section: Endoscopic Retrograde Cholangiopancreatographymentioning

confidence: 95%

“…Recently, a study reported the use of a standardized form for continuous self-assessment. The form included previously proposed quality indicators for ERCP such as procedural indication, degree of technical difficulty, previous ERCP failure, and success or failure options (such as cannulation of the common bile duct [CBD] or pancreatic duct, stent placement, sphincterotomy, and stone extraction) [9]. This method allowed not only for the quantitative evaluation of trainees, but also determined the learning curve of each individual and of the average group progression.…”

Section: Endoscopic Retrograde Cholangiopancreatographymentioning

confidence: 99%

Endoscopic Retrograde Cholangiopancreatography and Endoscopic Ultrasound: To Be One Traveler in Converging Roads

Moutinho-Ribeiro

Peixoto

Macedo³

2017

GE Port J Gastroenterol

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Background: Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) were initially introduced into the world of gastroenterology as purely diagnostic procedures. With progressive evolution of intervention, both these techniques conquered fields in the treatment of many conditions that had once been exclusively surgical domains. Nowadays, more and more clinical situations have an indication to perform both EUS and ERCP, and these two techniques are frequently required at the same time for the same patient. More than competitors, ERCP and EUS are truly complementary, with great ability for mutual aid. They share their main indications, equipment, accessories, and main technical gestures. Objectives and Methods: We review the major indications to perform both techniques, sequentially or complementarily, describe the common things that these two techniques essentially share, and discuss the ERCP-EUS single session. Also, the issues of learning curves and education of upcoming biliopancreatic endoscopists are highlighted. Conclusion: In recent years the complementation between ECRP and EUS has been growing both from a diagnostic and a therapeutic point of view, allowing optimization of the use of these techniques and the creation of a more systematized approach of patients with biliopancreatic pathology. Endoscopists with experience in both techniques will be increasingly important, suggesting a parallel formation in the training plans of future endoscopists with interest in the area.

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Optimizing cytological specimens of EUS‐FNA of solid pancreatic lesions: A pilot study to the effect of a smear preparation training for endoscopy personnel on sample quality and accuracy

Riet

Quispel

Cahen

et al. 2020

Diagnostic Cytopathology

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BackgroundIn the absence of rapid on‐side pathological evaluation, endoscopy staff generally “smears” endoscopic ultrasound guided fine needle aspiration (EUS‐FNA) specimens on a glass slide. As this technique is vulnerable to preparation artifacts, we assessed if its quality could be improved through a smear‐preparation‐training for endoscopy staff.MethodsIn this prospective pilot study, 10 endosonographers and 12 endoscopy nurses from seven regional EUS‐centers in the Netherlands were invited to participate in a EUS‐FNA smear‐preparation‐training. Subsequently, post training slides derived from solid pancreatic lesions were compared to pre‐training “control” slides. Primary outcome was to assess if the training positively affects smear quality and, consequently, diagnostic accuracy of EUS‐FNA of solid pancreatic lesions.ResultsParticipants collected and prepared 71 cases, mostly pancreatic head lesions (48%). Sixty‐eight controls were selected from the pretraining period. The presence of artifacts was comparable for smears performed before and after training (76% vs 82%, P = .36). Likewise, smear cellularity (≥50% target cells) before and after training did not differ (44% (30/68) vs 49% (35/71), P = .48). Similar, no difference in diagnostic accuracy for malignancy was detected (P = .10).ConclusionIn this pilot EUS‐FNA smear‐preparation‐training for endoscopy personnel, smear quality and diagnostic accuracy were not improved after the training. Based on these results, we plan to further study other training programs and possibilities.

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Competence development in ERCP: the learning curve of novice trainees

Abstract: Learning curves are a valuable means for assessing competence in ERCP. Differences in learning curves can be shown with RAF-E. Verification of competence should be based on actual performance, instead of minimum numbers.

Cited by 73 publications

References 15 publications

Training in ERCP and EUS in the UK anno 2017

Training in ERCP and EUS in the UK anno 2017

Endoscopic Retrograde Cholangiopancreatography and Endoscopic Ultrasound: To Be One Traveler in Converging Roads

Optimizing cytological specimens of EUS‐FNA of solid pancreatic lesions: A pilot study to the effect of a smear preparation training for endoscopy personnel on sample quality and accuracy

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