Learning curves for EUS by using cumulative sum analysis: implications for American Society for Gastrointestinal Endoscopy recommendations for training

Wani, Sachin; Coté, Gregory A.; Keswani, Rajesh N.; Mullady, Daniel; Azar, Riad R.; Murad, Faris; Edmundowicz, Steven A.; Komanduri, Srinadh; McHenry, Lee; Al‐Haddad, Mohammad; Hall, Matthew; Hovis, Christine E.; Hollander, Thomas; Early, Dayna S.

doi:10.1016/j.gie.2012.10.012

Cited by 140 publications

(121 citation statements)

References 22 publications

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“…The two studies on EUS described the performance per anatomic station of the procedure 70 72. There was a large variability in achieving overall competence, with acceptable performance after a range of 255–>400 EUS procedures 70.…”

Section: Resultsmentioning

confidence: 99%

Training and competence assessment in GI endoscopy: a systematic review

Ekkelenkamp

Koch

Man

et al. 2015

Gut

146

121

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The use of validated VR simulators in the early training setting accelerates the learning of practical skills. Learning curves are valuable for the continuous assessment of performance and are more relevant than threshold numbers. Future research will strengthen these conclusions by evaluating simulation-based as well as patient-based training in GI endoscopy. A complete curriculum with the assessment of competence throughout training needs to be developed for all GI endoscopy procedures.

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Section: Resultsmentioning

confidence: 99%

Training and competence assessment in GI endoscopy: a systematic review

Ekkelenkamp

Koch

Man

et al. 2015

Gut

146

121

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“…Indeed, EUS is an operator-dependent technique that requires considerable skills and training in EUS is essential to gain experience to reliably examine the pancreas. The intensity and length of training, the requisite curriculum and the minimum number of procedures required to ensure competency are not well-defined [158] . Some experts recommend a minimum of 75 pancreatobiliary procedures and 25 cases of pancreatic FNA [159] , others suggest a minimum of 30 supervised EUS-FNA on pancreatic lesions [160] while someones believe that the majority of trainees will require double the number of proposed procedures to achieve competency in EUS [161,162] .…”

Section: Resultsmentioning

confidence: 99%

Endoscopic ultrasonography for surveillance of individuals at high risk for pancreatic cancer

Lami

Biagini

Galli

2014

WJGE

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Pancreatic cancer is a highly lethal disease with a genetic susceptibility and familial aggregation found in 3%-16% of patients. Early diagnosis remains the only hope for curative treatment and improvement of prognosis. This can be reached by the implementation of an intensive screening program, actually recommended for individuals at high-risk for pancreatic cancer development. The aim of this strategy is to identify premalignant precursors or asymptomatic pancreatic cancer lesions, curable by surgery. Endoscopic ultrasound (EUS) with or without fine needle aspiration (FNA) seems to be the most promising technique for early detection of pancreatic cancer. It has been described as a highly sensitive and accurate tool, especially for small and cystic lesions. Pancreatic intraepithelial neoplasia, a precursor lesion which is highly represented in highrisk individuals, seems to have characteristics chronic pancreatitis-like changes well detected by EUS. Many screening protocols have demonstrated high diagnostic yields for pancreatic pre-malignant lesions, allowing prophylactic pancreatectomies. However, it shows a high interobserver variety even among experienced endosonographers and a low sensitivity in case of chronic pancreatitis. Some new techniques such as contrast-enhanced harmonic EUS, computer-aided diagnostic techniques, confocal laser endomicroscopy miniprobe and the detection of DNA abnormalities or protein markers by FNA, promise improvement of the diagnostic yield of EUS. As the resolution of imaging improves and as our knowledge of precursor lesions grows, we believe that EUS could become the most suitable method to detect curable pancreatic neoplasms in correctly identified asymptomatic at-risk patients.© 2014 Baishideng Publishing Group Inc. All rights reserved. Key words: Endoscopic ultrasonography; Pancreatic cancer; SurveillanceCore tip: In the era of early diagnosis and screening programs, endoscopic ultrasound (EUS) represents the most promising tool able to identify pancreatic precursor neoplasms in high risk individuals. If compared to other imaging techniques, it is highly accurate to diagnose small pancreatic cancer and pre-malignant lesions, with very low rate of complications and limitations. Here are reported the current role of EUS in various international screening programs and its future possible developments.

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“…14 Although technically easy, there is a learning curve to attain proficiency in EUS-FNA and the technology is not widely available. [15][16][17][18] Analysis of the claims data revealed that while EUS-FNA is increasingly being used, surgical biopsies are becoming less common. At present, at most major medical centers, the role of open surgical biopsies of the pancreas is relegated only to cases where multiple attempts at EUS-FNA are unsuccessful.…”

Section: Discussionmentioning

confidence: 99%