Training in Advanced Endoscopy

Abstract

Advanced endoscopy is vastly expanding in its practical implications and complexity. Over the years, the role of advanced endoscopic procedures has expanded from a primarily diagnostic to complex diagnostic and therapeutic procedures with many conditions that were managed surgically in the past being managed effectively with endoscopic approaches. With the increasing complexity of these procedures, training in advanced endoscopy has gained paramount importance. Training in advanced endoscopy requires acquisition of many skills – technical, cognitive, and integrative, those beyond standard endoscopic skills acquired during a 3-year training program. Expertise in basic endoscopy is a prerequisite for learning advanced endoscopy. Given the overall complexity of these procedures, adequate and appropriate training in advanced endoscopy is critical. These procedures are highly operator dependent and associated with higher rates of adverse events including life-threatening bleeding, perforation, and pancreatitis (Andriulli A, Loperfido S, Napolitano G, et al. Incidence rates of post-ERCP complications: a systematic survey of prospective studies. Am J Gastroenterol. 2007;102(8):1781–8). Given the changing healthcare landscape, reimbursements will soon be linked to performance and quality of care provided. Hence, in this era of value-based care, adequate training in advanced endoscopy is critical to ensure that quality metrics in endoscopy are being met.