Structured training program on confocal laser endomicroscopy for pancreatic cystic lesions: a multicenter prospective study among early-career endosonographers (with video)

Abstract

Background and aimsThere are limited data about how to teach endosonographers needle-based confocal laser endomicroscopy (nCLE)-guided histologic diagnosis of pancreatic cystic lesions (PCLs). Hence, we developed and tested a structured educational program to train early-career endosonographers in nCLE-guided diagnosis of PCLs. MethodsTwenty-one early-career nCLE-naive endosonographers watched a teaching module outlining nCLE criteria for diagnosing PCLs. Participants then reviewed 80 high-yield nCLE videos, recorded diagnoses, and received expert feedback (phase 1). Observers were then randomized to a refresher feedback session or self-learning at four weeks. Eight weeks after training, participants independently assessed the same 80 nCLE videos without feedback and provided histologic predictions (phase 2). Diagnostic performance of nCLE to differentiate mucinous vs. non-mucinous PCLs and to diagnose specific subtypes were analyzed using histopathology as the gold standard. Learning curves were determined using cumulative sum analysis (CUSUM). ResultsAccuracy and diagnostic confidence for differentiating mucinous vs. non-mucinous PCLs improved as endosonographers progressed through nCLE videos in phase 1 (p<0.001). Similar trends were observed with the diagnosis of PCL subtypes. Most participants achieved competency interpreting nCLE, requiring a median of 38 assessments (range 9-67). During phase 2, participants independently differentiated PCLs with high accuracy (89%), high confidence (83%), and substantial IOA (k=0.63). Accuracy for nCLE-guided PCL subtype diagnosis ranged from 82-96%. The learned nCLE skills did not deteriorate at eight weeks and were not impacted by a refresher session. ConclusionWe developed a practical, effective, and durable educational intervention to train early-career endosonographers in nCLE-guided diagnosis of PCLs.