Training in and Experience with Endobronchial Ultrasound

Bellinger, Christina; Chatterjee, Arjun B.; Adair, Norman E.; Houle, Timothy T.; Khan, Irtaza; Haponik, Edward F.

doi:10.1159/000368366

Cited by 27 publications

(21 citation statements)

References 28 publications

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“…The importance of the learning curve in the implementation of endoscopic ultrasound application and parallel improvement of diagnostic yield have been clearly demonstrated [21]. pime pime pime pime p pi im me e EDITRICE …”

Section: Discussionmentioning

confidence: 99%

Endobronchial ultrasound-guided transbronchial needle aspiration under conscious sedation with meperidine and midazolam

Agostini¹,

Facciolongo²,

Lusuardi

et al. 2017

Monaldi Arch Chest Dis

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Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) is usually performed under general anesthesia or deep sedation with drugs such as Propofol that, at least in Italy, can be administered only by an anesthesiologist. Aim of the study was to assess conscious sedation feasibility, safety and tolerability using meperidine and midazolam as administered by Pulmonologist and relevant impact on the efficiency of the sampling procedures.All patients undergoing EBUS-TBNA from February 2013 to July 2014 were examined retrospectively. Efficiency using Meperidine and Midazolam during EBUS-TBNA has been assessed: completion of lymphnodal sampling, sampling adequacy, diagnostic yield, cough during endoscopic procedure complications and need for procedure repetition with Anesthesiology assistance. Patient satisfaction and cost/effectiveness were also evaluated. One hundred and thirty-four consecutive patients were considered; 97.7% completed the procedure. In 96.9% of cases the prefixed program of lymph-nodal sampling was accomplished. Sampling adequacy was 92,4%. Diagnostic yield was 55%. In 94.7% of cases cough was absent or did not interfere with EBUS-TBNA. The need to repeat the endoscopic procedure occurred in 6 cases but only in 2 the presence of an Anesthesiologist was required. Patient satisfaction was very high, with 95.9% of subjects reporting they would "definitely return". A 27% cost reduction was calculated. EBUS-TBNA under conscious sedation using Meperidine and Midazolam prescribed and administered by pulmonologist without the Anesthesiologist assistance, revealed to be a safe, well tolerated and cost saving procedure. The efficiency of sampling was good, apart from a relatively low diagnostic yield due to different expertise of operators.

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Section: Discussionmentioning

confidence: 99%

Endobronchial ultrasound-guided transbronchial needle aspiration under conscious sedation with meperidine and midazolam

Agostini¹,

Facciolongo²,

Lusuardi

et al. 2017

Monaldi Arch Chest Dis

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“…Fifteen studies have described the learning curves for 43 operators performing EBUS (Table ) . Ten studies provided the number needed to gain proficiency based on the cumulative sensitivity over a period . Most of the studies were retrospective and were single centre.…”

Section: Resultsmentioning

confidence: 99%

Training and proficiency in endobronchial ultrasound‐guided transbronchial needle aspiration: A systematic review

et al. 2017

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Endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) is currently the modality of choice for evaluation of mediastinal lymphadenopathy. However, there is still uncertainty regarding the training methodology and the number of procedures required to attain proficiency in EBUS. Herein, we performed a systematic review of studies selected from PubMed, EmBase and Scopus databases describing the training and assessment of proficiency during EBUS, specifically studies investigating various methods for training, its outcome and the number of procedures required to overcome the learning curve for EBUS. Twenty-seven (simulator-based learning (n = 8), tools for assessing competence in EBUS-TBNA (n = 5) and threshold numbers needed to attain proficiency in EBUS-TBNA (n = 16)) studies were identified. An EBUS simulator accurately stratified individuals based on the level of experience in performing EBUS. Training received on a simulator was comparable with traditional apprentice-based training. Importantly, skills acquired on a simulator could be transferred to realworld patients. The number needed to overcome the initial learning curve of EBUS varied from 10 to 100 in individual studies with a mean of 37-44 procedures. Tools such as EBUS-STAT (EBUS skill and task assessment tool) and EBUSAT (EBUS skill and assessment tool) were effective in evaluating the EBUS trainees. We conclude that an EBUS simulator or EBUS assessment tools can objectively assess the training of an EBUS trainee. Simulator-based training is a useful modality in EBUS training. The number of procedures needed to overcome the initial learning curve is about 40. Centres involved in EBUS training could incorporate simulator-based training in their curriculum before allowing operators to perform EBUS on patients.

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“…Hu et al [16] reported that the minimum operation cases needed to reach 90% ACC was 22. Bellinger et al [33] reported that a minimum of 20-25 procedures is needed to achieve acceptable yields. Our study showed similar results achieved by the ST and T groups.…”

Section: Discussionmentioning

confidence: 99%

A Comparison of Different Training Methods in the Successful Learning of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration

et al. 2017

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Background: Standardized training of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS- TBNA) is available only in highly developed countries. Objective: To compare the skill differences in the performance of EBUS-TBNA by pulmonologists trained under different learning methods. Methods: We performed a retrospective study of 145 EBUS-TBNA cases. We set up 3 comparative training groups: a standardized training group, a teaching group, and a self-study group. The main clinical outcomes were sensitivity, specificity and accuracy of EBUS-TBNA. Cumulative sum analysis was used to track EBUS-TBNA proficiency of the 3 groups. Results: The sensitivities of EBUS-TBNA in the different groups were 90, 88, and 67%, respectively. The accuracies of the different groups were 91, 90, and 71%, respectively. With respect to the sensitivity and accuracy, there was no significant difference between the standardized training group and teaching group. However, the self-study group was inferior to the other 2 groups. By comparing the learning curve among the groups, we found that the minimum number of operations needed to reach a 90% accuracy for the standardized training group, the teaching group and the self-study group was 17, 32 and 40 cases, respectively. Conclusion: Compared with the teaching and self-study groups, the standardized training group resulted in practitioners achieving high skill levels following the performance of a lower number of cases. Pulmonologists trained in the teaching group achieved a similar level of skills, but required more experience to reach this level. Practitioners in the self-study group did not achieve a satisfactory level of skills, despite performing a high number of cases.

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Training in and Experience with Endobronchial Ultrasound

Cited by 27 publications

References 28 publications

Endobronchial ultrasound-guided transbronchial needle aspiration under conscious sedation with meperidine and midazolam

Endobronchial ultrasound-guided transbronchial needle aspiration under conscious sedation with meperidine and midazolam

Training and proficiency in endobronchial ultrasound‐guided transbronchial needle aspiration: A systematic review

A Comparison of Different Training Methods in the Successful Learning of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration

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