Surgical OGD – a dying art?

Abstract

Surgical trainees are poorly trained and do not have the necessary skills to provide an emergency service for upper GI haemorrhage. Emergency endoscopy facilities are severely under resourced.

Operative experience in the Victorian general surgical training programme

“…the trainee performed the endoscopic procedure as the primary operator). The significantly increased gastroscopy and colonoscopy experience obtained on rural rotations is likely to reflect on the monopoly that gastroenterologists and gastroenterology trainees have on the performance of endoscopies in metropolitan hospitals, whereas rural surgeons and their surgical trainees are likely to perform endoscopies in rural hospitals 23,24 . In our study, the average number of gastroscopies performed in a non‐rural rotation per 6 months per trainee was 11.6.…”

“…Given a 5‐year training period (10 6‐month terms), it would appear from our study that the trainee who does not spend time in a rural term would find it difficult to meet RACS minimum endoscopy requirements for awarding of a Fellowship in General Surgery. A recently published survey of English surgical trainees highlighted similar deficiencies in trainee endoscopy experiences, especially emergency upper gastrointestinal endoscopies 24 . Some 83% of specialist surgical registrars in the South Thames region were in training posts that did not provide adequate exposure to elective endoscopy experiences.…”

“…Some 83% of specialist surgical registrars in the South Thames region were in training posts that did not provide adequate exposure to elective endoscopy experiences. Less than 50% were able to perform therapeutic injections at emergency endoscopies 24 . At present, there is no data on the competency of Australian surgical trainees in performing emergency therapeutic endoscopy, as this is not covered by the current log book.…”

Surgical Endoscopy Training in England

“…This is particularly relevant given the fact that some papers have questioned the suitability of surgeons as emergency endoscopists. 3 Finally, it is well recognised that endoscopic skills are necessary for the screening and surveillance of colorectal cancers as well as the provision of upper and lower gastrointestinal (GI) emergency services. But we shall also look at the perceived relevance of endoscopy training for surgical trainees in the light of emerging minimal access interventions, principally natural orifice transluminal endoscopic surgery (NOTES) techniques.…”