Competence development of trainees performing short‐type single‐balloon enteroscopy‐assisted endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy

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.

Advanced technical tips and recent insights in ERCP using balloon‐assisted endoscopy

“…According to recent reports on the education of trainees for mastering the technique of BAE-ERCP, first, trainees should gain experience starting with the Child (modified) procedure, in which scope insertion is considered relatively easier. 41,42 As for biliary cannulation, although there is no significant difference in success rates between approaches to the major papilla and choledocojejunal anastomotic site, the procedure time was significantly longer for the approach to the major papilla, 43 which suggests initial performance should be for the approach to the choledocojejunal anastomotic site.…”

“…Furthermore, it has been reported that trainees with experience in colonoscopy and ERCP have higher success rates in BAE-ERCP. 41 BAE-ERCP requires comprehensive mastery of various endoscopic techniques. Moreover, as BAE-ERCP is a subtype of ERCP, it is fundamental to master ERCP, which is the basis of pancreatobiliary endoscopic treatment, and efforts should be made to master BAE-ERCP techniques as an advanced ERCP.…”

“…Lastly, reports suggest the importance of opportunities to learn expert techniques 44 and indicate that success rates improve with increasing experience. 15,[41][42][43][44] Therefore, enhancing the training system and mentorship at each institution is a crucial task for the future.…”

“…Furthermore, it has been reported that trainees with experience in colonoscopy and ERCP have higher success rates in BAE‐ERCP 41 . BAE‐ERCP requires comprehensive mastery of various endoscopic techniques.…”

Single-balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy: a technical review

“…Short SBE can be used with many of accessories needed in procedures, such as stone extraction or SEMS placement. [11][12][13] The reported total procedural success rate of short SBE-assisted ERCP ranged between 70.4% to 85.9% (Table 1). [14][15][16][17] A recent multi-center study of short SBE-assisted ERCP in patients with SAA reported a total procedural success and adverse event rate of 74.9% and 7.7%, respectively.…”