Endoscopic Ultrasound Training Research Articles

Curriculum for diagnostic endoscopic ultrasound training in Europe: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement.

The European Society of Gastrointestinal Endoscopy (ESGE) has recognized the need to formalize and enhance training in diagnostic endoscopic ultrasound (EUS). This manuscript represents the outcome of a formal Delphi process resulting in an official Position Statement of the ESGE and provides a framework to develop and maintain skills in diagnostic EUS. This curriculum is set out in terms of the prerequisites prior to training; the recommended steps of training to a defined syllabus; the quality of training; and how competence should be defined and evidenced before independent practice. 1: Trainees should have achieved competence in upper gastrointestinal endoscopy before training in diagnostic EUS. 2: The development of diagnostic EUS skills by methods that do not involve patients is advisable, but not mandatory, prior to commencing formal training in diagnostic EUS. 3: A trainee's principal trainer should be performing adequate volumes of diagnostic EUSs to demonstrate maintenance of their own competence. 4: Training centers for diagnostic EUS should offer expertise, as well as a high volume of procedures per year, to ensure an optimal level of quality for training. Under these conditions, training centers should be able to provide trainees with a sufficient wealth of experience in diagnostic EUS for at least 12 months. 5: Trainees should engage in formal training and supplement this with a range of learning resources for diagnostic EUS, including EUS-guided fine-needle aspiration and biopsy (FNA/FNB). 6: EUS training should follow a structured syllabus to guide the learning program. 7: A minimum procedure volume should be offered to trainees during diagnostic EUS training to ensure that they have the opportunity to achieve competence in the technique. To evaluate competence in diagnostic EUS, trainees should have completed a minimum of 250 supervised EUS procedures: 80 for luminal tumors, 20 for subepithelial lesions, and 150 for pancreaticobiliary lesions. At least 75 EUS-FNA/FNBs should be performed, including mostly pancreaticobiliary lesions. 8: Competence assessment in diagnostic EUS should take into consideration not only technical skills, but also cognitive and integrative skills. A reliable valid assessment tool should be used regularly during diagnostic EUS training to track the acquisition of competence and to support trainee feedback. 9: A period of supervised practice should follow the start of independent activity. Supervision can be delivered either on site if other colleagues are already practicing EUS or by maintaining contacts with the training center and/or other EUS experts. 10: Key performance measures including the annual number of procedures, frequency of obtaining a diagnostic sample during EUS-FNA/FNB, and adverse events should be recorded within an electronic documentation system and evaluated.

UK and Ireland Joint Advisory Group (JAG) consensus statements for training and certification in diagnostic endoscopic ultrasound (EUS)

Background and aimsInternational endoscopy societies vary in their approach for credentialing individuals in endoscopic ultrasound (EUS) to enable independent practice; however, there is no consensus in this or its implementation....

A portrait of Endoscopic retrograde cholangiopancreatography and endoscopic ultrasound training programs in Europe: Current practices and opportunities for improvement.

Endoscopic retrograde cholangiopancreatography (ERCP) and EUS are challenging procedures requiring a high level of expertise to provide effective and safe patient care. Thus, high-quality training is needed to achieve competence. We aimed to evaluate the status of European ERCP/EUS training programs, to evaluate adherence to international recommendations, and to propose possible solutions for future improvements. A web-based survey was developed and ERCP/EUS experts and trainees across Europe were invited to participate. Forty-one experts (out of 50; 82%) and 30 trainees (out of 70; 42.9%) from 18 countries answered the questionnaire. The training program application process is mainly driven by individual requests (87.8%). All surveyed departments offer combined ERCP/EUS training and the majority have adequate facilities and trainers. Although centers are high-volume and provide long-term fellowships, trainee hands-on exposure is not very high (43% expect to do (or did) 100-150 ERCPs and 69% up to 150 EUSs). A formal curriculum is in place in 53.7% centers, including simulation-training in 27.3%. Competence is assessed in 65.7% of centers, but validated tools are applied in only 33.3%. This survey first provides an overview of ERCP/EUS training programs across Europe. It shows that there is adherence to international guidelines to a certain degree, but several gaps in the application process, use of simulators for training, training curriculum and assessment of performance have been recognized. Overcoming these shortcomings could serve as a basis for further improvement in ERCP/EUS training.

Development and validation of a novel porcine bile duct dilation model for EUS training.

Background and study aims Image-guided minimally invasive techniques have transformed the management of malignant and benign bile duct obstructions. These evolving techniques are being widely adopted and applied and hands-on training using high quality models is required to improve the proficiency of practitioners. This experimental study aimed to validate an in vivo porcine model created to simulate bile duct dilation for interventional endoscopic ultrasound (EUS) hands-on training curriculums. Materials and methods Thirty-six porcine models were involved and the procedures were performed in an experimental hybrid operating room under general anesthesia. Animals underwent endoscopic duodenal papilla clipping with several hemostatic metallic clips. After a survival period of 24 to 48 hours, the models with effective intrahepatic and extrahepatic bile duct dilatation were included in the hands-on training. Trainees and faculty were given structured evaluations of the model realism and usefulness. Results Extrahepatic bile duct and gallbladder dilation was achieved in all 36 of the models, and in 11 of the 36 models, a treatable intrahepatic duct dilatation was achieved. During the hands-on training, EUS-guided biliary drainage, EUS-guided transgastric gallbladder drainage, and EUS through-the-needle microbiopsy forceps procedures were feasible. Overall, 75 % of the experts and trainees evaluated the training as excellent. Conclusions We present a minimally invasive, reliable and time- effective model of extrahepatic dilation suitable for interventions. The model was less effective for intrahepatic ducts, which should be considered if intrahepatic biliary dilation is required for training.

A structured Endoscopic Ultrasound training program in Germany improves knowledge and competence.

Limited evidence on how to organize pre-patient training in Endoscopic Ultrasound (EUS) and how to evaluate its effect on knowledge and skills are available. The aim of our study was to assess the impact of a structured multi-site training program on EUS competence in Germany. In a prospective study design, evaluation of 64 trainees was conducted during four three-day training courses with equal curricula at three sites. Participants completed a structured pre- and post-test questionnaire consisting of 4 items to evaluate the relevance and acceptance of the training components (theoretical teaching, video sessions, live demonstration, hands-on experience) on a 5-point Likert scale, as well as a Likert scale to judge the self-rated improvement in EUS competence. To assess knowledge, 12 multiple choice (MC) questions had to be answered by all participants in a pre- and a post-test design. Also differences between beginners and advanced learners were analysed. Overall evaluation on acceptance received above-average results with a median of 4 or 5 (IQR 1-2) on Likert scale (1=completely disagree, 5=completely agree). In the post-test self-rated EUS skills improved from 4 to 2 on the Likert scale (IQR=1, p=0.001, 1=excellent EUS skills, 5=no EUS skills). Results of the MC-test of all trainees showed significant improvement in theoretical knowledge from 7.9±1.9 to 8.8±1.9 points (mean±SD, p=0.001). Our study provides arguments for the usefulness of a structured EUS training program resulting in a positive acceptance and high self-rated EUS competence by the participants and significant improvements in knowledge.

Curriculum for ERCP and endoscopic ultrasound training in Europe: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement.

The European Society of Gastrointestinal Endoscopy (ESGE) has recognized the need to formalize and enhance training in endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS). This manuscript represents the outcome of a formal Delphi process resulting in an official Position Statement of the ESGE and provides a framework to develop and maintain skills in ERCP and EUS. This curriculum is set out in terms of the prerequisites prior to training; recommended steps of training to a defined syllabus; the quality of training; and how competence should be defined and evidenced before independent practice. 1: Trainees should be competent in gastroscopy prior to commencing training. Formal training courses and the use of simulation in training are recommended. 2: Trainees should keep a contemporaneous logbook of their procedures, including key performance indicators and the degree of independence. Structured formative assessment is encouraged to enhance feedback. There should be a summative assessment process prior to commencing independent practice to ensure there is robust evidence of competence. This evidence should include a review of a trainee's procedure volume and current performance measures. A period of mentoring is strongly recommended in the early stages of independent practice. 3: Specifically for ERCP, all trainees should be competent up to Schutz level 2 complexity (management of distal biliary strictures and stones > 10 mm), with advanced ERCP requiring a further period of training. Prior to independent practice, ESGE recommends that a trainee can evidence a procedure volume of > 300 cases, a native papilla cannulation rate of ≥ 80 % (90 % after a period of mentored independent practice), complete stones clearance of ≥ 85 %, and successful stenting of distal biliary strictures of ≥ 90 % (90 % and 95 % respectively after a mentored period of independent practice). 4: The progression of EUS training and competence attainment should start from diagnostic EUS and then proceed to basic therapeutic EUS, and finally to advanced therapeutic EUS. Before independent practice, ESGE recommends that a trainee can evidence a procedure volume of > 250 cases (75 fine-needle aspirations/biopsies [FNA/FNBs]), satisfactory visualization of key anatomical landmarks in ≥ 90 % of cases, and an FNA/FNB accuracy rate of ≥ 85 %. ESGE recognizes the often inadequate quality of the evidence and the need for further studies pertaining to training in advanced endoscopy, particularly in relation to therapeutic EUS.

Feasibility of an EUS e-training course with live cases

Background and study aims One-on-one endoscopic ultrasound (EUS) mentorship was not possible at most institutions during the COVID-19 pandemic. We decided to test the feasibility of structured training in EUS with virtual e-classes with live cases. The aim of this study was to assess the feasibility of a virtual EUS training course with objective end points. Patients and methods Twenty-one trainees were trained on a virtual platform over 16 classes of 90 minutes each, over 3 months. The virtual training screen had two equal parts, one showing the endoscopist’s hand movements, and another the resultant EUS display. The course curriculum included EUS anatomy of the mediastinum, pancreatico-biliary region and rectum. The assessment was done on videos of procedures performed by trainees. Results Twenty trainees performed 251 EUS procedures (range 8–25, mean 12.5 ± 4.9) at their institutions. At the end of the course, all students (100 %) could maneuver the echo-endoscope through to the duodenum. Fifteen trainees sent a video for final assessment. The successful specified area identification rates were 12 of 15 (80 %) for the subcarinal space, 10 of15 (66.6 %) for the head of the pancreas, 10 of 15 (66.6 %) for the common bile duct, and nine of 15 (60 %) for the tail of pancreas. The success rate of ability to get appropriate windows was 10 of 15 (67 %) for the subcarinal space, eight of 15 (53.3 %) for the head of the pancreas, seven of 15 (46.6 %) for the common bile duct and six of 15 (40 %) for the tail of pancreas. No adverse events were reported. Conclusions A virtual EUS training course with live cases appears feasible. It allows the possibility of training a large number of students. Further evaluation is needed, especially of virtual assessment methods and training benchmarks.

Changing perspectives in the training of endoscopic ultrasonography in Asia.

Training of endoscopic ultrasound (EUS) in Asia faces challenges of the ever‐increasing demand for skills to handle a growing range of both diagnostic and interventional EUS procedures, and a continual shortage of EUS training programs. To keep up with the pace of development in EUS, more short‐term EUS programs have been conducted across Asia in recent years. In this aspect, the Asian EUS Group (AEG) has taken the lead to fast‐track the dissemination of EUS knowledge and skills across Asia through its multinational network of training centers. AEG's programs are brought to wherever there is demand. Its versatile modular structure allows the program to be easily customized and scaled up or down to align to local needs, making it highly adaptable to the changing and varying needs in different countries. Even with the current pandemic situation, it has been able to continue its training efforts through the use of technology, including webinars, and live case demonstration.

Sa1478 DOES OVERALL VOLUME OF ENDOSONOGRAPHER AFFECT OVERALL DIAGNOSTIC ACCURACY OF EUS-FNA OF SOLID PANCREATIC LESIONS: OUTCOMES FROM A LARGE HEALTH CARE SYSTEM COMPRISING OF BOTH ACADEMIC AND COMMUNITY PRACTICE

Endoscopic ultrasound (EUS) guided sampling with fine needle aspiration (FNA) or fine needle biopsy (FNB) is the standard of care for diagnosis of solid pancreatic lesions. Over last decade, a large number of gastroenterologists have received dedicated training in EUS as well as ERCP. For ERCP, overall low volume is associated with more adverse events and negative patient outcomes. However, data regarding volume of endosonographer and overall clinical outcomes for patient is not available. Aim of this study was to examine impact of volume of endosonographer on overall adequacy and diagnostic accuracy of EUS guided FNA of pancreatic solid lesions (PSLs). EUS FNA is currently performed in 6 out of 14 hospitals of our health care system. Total 19 endosonographers performed over 3000 EUS between 2015 to 2019. From this prospective maintained database, we retrospectively reviewed EUS FNA cases for PSLs. One endosonographer performed 50 or more EUS FNA of PSL per year while other 18 endosongraphers performed less than 50 EUS FNA of PSL each per year. The collected data included patient demographics, PSL size, needle gauge, needle type, adequacy of the obtained sample, the percentage of diagnostic samples and accuracy of diagnosis. Mean age of the study population was 65+14. A total of 575 EUS-FNA of PSL were performed by all endosonographers. The high volume endosonographer (HVE) performed 242 EUS-FNA of PSL over a period of 4 years with more than 50 procedures per year. The low volume endosonographers (LVE) performed 333 EUS-FNA of PSL over the same period, each performing less than 50 procedures per year. There was no difference in mean size of PSL between both groups. Overall, LVE had significantly higher number 69/333 (20.7%) of inadequate samples compared to 40/242 (16.5%) inadequate samples for HVE (P <0.01). Similarly, overall diagnostic accuracy was much lower for LVE 244/333 (73.3%) compared to diagnostic accuracy of HVE 194/242 (80.2%) (P < 0.01). Overall low procedure volume of endosonographer is significantly associated with higher inadequate samples and lower diagnostic yield compared to high volume endosonographers.

Advanced Endoscopy Trainee Involvement Early in EUS Training May Be Associated with an Increased Risk of Adverse Events.

BackgroundThe quality of endoscopic ultrasound (EUS) involving advanced endoscopy trainees (AETs) is not well understood. In this study, we aimed to examine adverse events (AE) risk and diagnostic yield of EUS procedures involving AETs.MethodsWe conducted a retrospective single-centre review from September 2009 to August 2015. Clinical, procedural, cytological, and hospital visit data within 30 days of the EUS procedure was collected. Primary outcomes were occurrence of an AE and a diagnostic specimen on cytopathology. Each AE was classified as “definitely related,” “possibly related,” or “not related” to the EUS procedure based on a previously defined consensus approach. Advanced endoscopy trainee involvement was established through the operative report.ResultsOur study included 1657 EUS procedures, of which 27% (451 of 1657) involved AETs. Endoscopic ultrasound was most commonly performed to evaluate pancreatic pathology (46% of cases). Overall AE incidence was 3.4%; it was 4.9% when an AET was involved and 2.8% when the EUS was performed without an AET (P = 0.04). The risk of an AE when AETs were involved was greatest in the first three months of training (7.9% versus 2.7%, P = 0.04). Multivariate analysis limited to the first three months of training demonstrated AET involvement to be associated with an increased AE risk after adjusting for patient and procedural factors (adjusted OR 3.2; 95% CI, 1.1–8.7; P = 0.03). The overall diagnostic yield was 76%. This was not compromised by AET involvement for any quartile of training.ConclusionsWe observed an increased risk of EUS-related AEs when procedures involved AETs during the first three months of training.

State of endoscopic ultrasonography in Spain in 2017

Abstract Aim To understand the current state of endoscopic ultrasonography (EUS) in Spain. Methods Descriptive analysis from a national survey with 11 questions: 10 related to technique and 1 to the training and experience of the endoscopists. Results Sixty endoscopists from 48 of the 97 (49.5%) hospitals that perform EUS in Spain responded to the survey. A total of 28,678 procedures (20,311 diagnostic, 7446 with puncture and 921 therapeutic) were recorded over the course of one year. Approximately 64% of the hospitals perform between 300 and 999 tests per year. All have radial and sectorial echoendoscopes, with a median of 2 (2–8) scopes. For cytological diagnosis, the 22-gauge needle is the most commonly used (98%) and, for histological diagnosis, the Procore (72%). The study of the pancreas and bile duct is the most common indication for diagnostic EUS (60%), followed by the staging of digestive tract neoplasms (20%). Approximately 72% of the hospitals perform on-site cytopathology evaluations and sedation is administered in equal parts by both endoscopists and anaesthetists. In terms of experience, 45% of echoendoscopists perform fewer than 300 annual exams and the median training duration is 6 months (0.5–36). Conclusions EUS is adequately implemented in Spain and good equipment is available. However, it is necessary to establish a standardised EUS training programme since the one undertaken by many echoendoscopists could prove insufficient according to the standards established by Scientific Societies.

Primary application of progressive teaching on endoscopic ultrasonography training program

Objective To compare the effect of progressive teaching pattern with traditional long-term training on improvement of trainees ability of endoscopic ultrasonography (EUS). Methods Ten learners who have achieved competence on routine endoscopic procedures but without any knowledge and skills on EUS procedures were enrolled in the study, and were randomly divided into two groups according to the sequence number. Learners with odd number received traditional long-term training, and the even number learners received progressive teaching. The proficiency of EUS knowledge and skills in the two groups were compared after one-year learning. Results At the final examination, the learners′ ability of mastering EUS was higher, and the study leave time was shorter in the progressive teaching group than that in the traditional long-term training group. however, we didn′t have a statistical comparison owing to the few numbers of trainees. Conclusion Progressive teaching pattern is superior to the traditional training, and it should be advocated when hospitals are relatively understaffed. Key words: Endosonography; Training program; Progressive teaching

Estado de la ecoendoscopia en España en 2017

AimTo understand the current state of endoscopic ultrasonography (EUS) in Spain. MethodsDescriptive analysis from a national survey with 11 questions: 10 related to technique and 1 to the training and experience of the endoscopists. ResultsSixty endoscopists from 48 of the 97 (49.5%) hospitals that perform EUS in Spain responded to the survey. A total of 28,678 procedures (20,311 diagnostic, 7,446 with puncture and 921 therapeutic) were recorded over the course of one year. Approximately 64% of the hospitals perform between 300 and 999 tests per year. All have radial and sectorial echoendoscopes, with a median of 2 (2-8) scopes. For cytological diagnosis, the 22-gauge needle is the most commonly used (98%) and, for histological diagnosis, the Procore (72%). The study of the pancreas and bile duct is the most common indication for diagnostic EUS (60%), followed by the staging of digestive tract neoplasms (20%). Approximately 72% of the hospitals perform on-site cytopathology evaluations and sedation is administered in equal parts by both endoscopists and anaesthetists. In terms of experience, 45% of echoendoscopists perform fewer than 300 annual exams and the median training duration is 6months (0.5-36). ConclusionsEUS is adequately implemented in Spain and good equipment is available. However, it is necessary to establish a standardised EUS training program since the one undertaken by many echoendoscopists could prove insufficient according to the standards established by Scientific Societies.

Endoscopic ultrasound in pediatric population: a comprehensive review of the literature.

Background and aim: Endoscopic ultrasonography (EUS) with or without fine needle aspiration/biopsy (FNA/B) is a well-established diagnostic tool in adults for the evaluation and management of gastrointestinal (GI) tract disorders. Its use in children is still limited as well as literature in pediatric age is limited, although the application of EUS is now increasing. The present article aims to review the current literature about EUS indication, accuracy and safety in pediatric age. Methods: Electronic literature searches were conducted using Pubmed, Medline, Embase, and the Cochrane Central Register of Controlled Trials using the word pediatric endoscopic ultrasound, pediatric pancreaticobiliary AND/OR EUS, pediatric EUS technique. Main patients and procedures characteristics were analyzed. The primary endpoint was the indication of EUS. Secondary endpoints were the accuracy of the technique and the incidence of complications. Results: Data were extracted from 19 articles. A total of 571 patients were investigated, with a median age of 12,7 years. A total of 634 EUS procedures were performed. The majority of EUS procedures investigated the pancreaticobiliary tract (77,7%). Most studies showed a high positive impact on management with a median value of 81,7%. No major complications were reported. Five studies reported minor complications with a median value of 2%. Conclusions: EUS is safe and has a significant role in the diagnosis of pancreaticobiliary and GI diseases even in children, with a high therapeutic success. An increasing EUS utilization by pediatric gastroenterologists is expected and offering dedicated EUS training to some selected pediatric gastroenterologists might be indicated. (www.actabiomedica.it)

Training in Endoscopy: Endoscopic Ultrasound

Endoscopic ultrasound (EUS) has been recently established as an indispensable modality for the diagnosis and management of pancreatobiliary and gastrointestinal (GI) disorders. EUS proficiency requires both cognitive and technical abilities, including an understanding of the appropriate indications, the performance of appropriate evaluations before and after the procedure, and the management of procedure-related complications. An increasing demand for skills to handle a growing range of interventional EUS procedures and a continual shortage of EUS training programs are two major obstacles for EUS training. Acquiring the skills necessary to comprehend and conduct EUS often requires training beyond the scope of a standard GI fellowship program. In addition to traditional formal EUS training and preceptorships, regular short-term intensive EUS training programs that provide training at various levels may help EUS practitioners improve and maintain EUS-related knowledges and skills. Theoretical knowledge can be acquired from lectures, textbooks, atlases, slides, videotapes, digital video discs, interactive compact discs, and websites. Informal EUS training is generally based on 1- or 2-day intensive seminars, including didactic lectures, skills demonstrated by expert practitioners through live video-streaming of procedures, and hands-on learning using animal or phantom models.

When trainees reach competency in performing endoscopic ultrasound: a systematic review.

Background/Study aim The American Society for Gastrointestinal Endoscopy (ASGE) recommends that trainees complete 150 endoscopic ultrasound (EUS) procedures before assessing competency. However, this recommendation is largely based on limited evidence and expert opinion. With new evidence suggesting that this historical threshold is underestimating training requirements, we evaluated the learning curve for achieving competency in EUS. Patients/Materials and methods Two investigators independently searched MEDLINE for full-text citations assessing the learning curve for achieving competency in EUS in the period 1946 to 25 March 2016. A learning curve was defined as either a tabulated or graphic representation of competency as a function of increasing EUS experience. Results Eight studies assessing 28 trainees and 7051 EUS procedures were included. When stratifying studies based on procedural indication: three studies assessed competency in evaluating mucosal lesions, three studies assessed competency in EUS fine-needle aspiration (EUS-FNA), and two studies assessed comprehensive competency. Among studies assessing mucosal lesion T-staging accuracy, competency was achieved by 65 to 231 procedures. Among studies assessing EUS-FNA, competency was achieved by 30 to 40 procedures. Among the two studies assessing comprehensive competency in EUS, competency was not achieved in either study across all trainees. Only four of 17 trainees reached competency by 225 to 295 EUS procedures. Conclusion As EUS competency assessment has evolved to more closely reflect independent clinical practice, the number of procedures required to achieve competency has risen well above ASGE recommendations. Advanced endoscopy training programs and specialty societies need to re-assess the structure of EUS training.

Training in endoscopic ultrasonography: An Asian perspective.

Training of endoscopic ultrasonography (EUS) in Asia faces two major challenges: (i) the ever-increasing demand for skills to handle a growing range of interventional EUS procedures; and (ii) a continual shortage of EUS training programs. As the therapeutic application of EUS continues to expand, the need to train more new endosonographers and upgrade skills of existing ones has become more critical than ever before. A formal fellowship to acquire EUS knowledge and skills in an advanced endoscopy center has always been perceived as the best way of training novices, but such opportunities remain limited in most Asian countries. To keep up with the pace of development in EUS, more short-term EUS programs have been conducted across Asia in recent years. Such programs are generally intensive and may combine didactic lectures, live-case demonstrations, and hands-on training on phantoms, or live animal models for teaching. Although not as rigorous as conventional full-time EUS fellowships, such short-term programs are not necessarily inferior in quality. With courses offered from basic to advanced levels, and at regular intervals, busy practising endoscopists have the flexibility to attend the course that best matches their individual levels of experience, learn at their own pace and acquire EUS knowledge and skills over as many courses as desired. This open-ended progressive learning model is more agile than established fixed-term learning models and is expected to adapt better to future needs.

When Trainees Reach Competency in Performing EUS: A Systematic Review

Introduction: National guidelines currently advocate for the completion of 150 endoscopic ultrasound (EUS) procedures prior to assessing trainee competency. However, these recommendations were founded on expert opinion and limited evidence. In the era of competency-based medical education new evidence has emerged suggesting that this historical procedural threshold is underestimating training requirements. Therefore, we systematically evaluated the learning curve for achieving competency in EUS. Methods: Two authors independently searched MEDLINE from 1946 to March 25, 2016 as well as the grey literature for full-text citations assessing the learning curve for EUS competency. A learning curve was defined as either a tabulated or graphic depiction of competency as a function of rising EUS experience with a minimum of two data points along the learning curve being required. Results: In total 8 studies warranted inclusion, which assessed 28 trainees and 7051 EUS procedures. Upon study stratification: 3 studies assessed mucosal lesion evaluation, 3 studies assessed EUS fine needle aspiration (EUS-FNA) and 2 studies assessed comprehensive competency. Concerning the 3 studies, which assessed mucosal lesion T-staging accuracy, competency was achieved by 65 to 231 EUS procedures. Concerning the 3 studies, which assessed EUS-FNA, competency was achieved by 30 to 40 EUS procedures. Of the 2 studies, which assessed comprehensive competency, only 4 of 17 trainees achieved competency by 225 to 295 EUS procedures. Conclusion: As competency assessment in EUS has matured to now use comprehensive competency, which more closely reflects clinical practice, the number of EUS procedures required to obtain competency has surpassed current recommendations. Therefore, specialty societies and advanced endoscopy training programs need to revisit the current structure of EUS training.

Learning models for endoscopic ultrasonography in gastrointestinal endoscopy.

Endoscopic ultrasonography (EUS) has become a useful diagnostic and therapeutic modality in gastrointestinal endoscopy. However, EUS requires additional training since it requires simultaneous endoscopic manipulation and ultrasonographic interpretation. Obtaining adequate EUS training can be challenging since EUS is highly operator-dependent and training on actual patients can be associated with an increased risk of complications including inaccurate diagnosis. Therefore, several models have been developed to help facilitate training of EUS. The models currently available for EUS training include computer-based simulators, phantoms, ex vivo models, and live animal models. Although each model has its own merits and limitations, the value of these different models is rather complementary than competitive. However, there is a lack of objective data regarding the efficacy of each model with recommendations on the use of various training models based on expert opinion only. Therefore, objective studies evaluating the efficacy of various EUS training models on technical and clinical outcomes are still needed.

Prior radial-scanning endoscopic ultrasonography training did not contribute to subsequent linear-array endoscopic ultrasonography study performance in the stomach of a porcine model.

Background/AimsThe optimal training mode for linear array endoscopic ultrasonography (EUS) has not been established. Prior radial-scanning EUS training seems to improve subsequent linear array EUS learning. The objective of this randomized controlled trial was to evaluate its value in linear array EUS training.MethodsIn total, 18 freshman trainees conducted hands-on EUS operations on a live pig model. The training contents consisted of visualization and tracking of the pancreas and splanchnic vasculature and performing fine-needle aspiration of the body or tail of the pancreas and celiac plexus neurolysis through the stomach. The trainees were randomized into two groups: group A received linear array EUS training after receiving radial-scanning EUS training, whereas group B conducted linear array EUS training alone. Two teachers assessed the competence of each trainee using a scoring system and relevant parameters before and after the training process.ResultsGroups A and B showed significant improvement between the pretests and posttests in terms of diagnostic and interventional procedures. There was no intergroup difference in terms of improvement.ConclusionsPrior radial-scanning EUS training did not contribute to subsequent linear array EUS study performance in the pig stomach model; thus, this training mode may need to be changed.