Elsevier

Gastrointestinal Endoscopy

Volume 58, Issue 3, September 2003, Pages 345-349
Gastrointestinal Endoscopy

Original Articles
Perceptions of Gastroenterology Fellows Regarding ERCP Competency and Training

https://doi.org/10.1067/S0016-5107(03)00006-3Get rights and content

Abstract

Background:

The adequacy of ERCP training in the United States may be suboptimal because many training programs do not provide fellows with the exposure to the procedures necessary to achieve competence.

Methods:

A short survey questionnaire, which assesses the training program, the personal ERCP experience, the perceptions regarding training adequacy, and the post-training practice plans, was sent to all fellows graduating from gastroenterology training programs.

Results:

Graduating fellows performed a median of 140 ERCPs and 35 sphincterotomies during training, with an associated median comfort level for independently performing sphincterotomy of 7.5 on a scale of 1 to 10. The median estimated success rate for independent free cannulation was 75%. Based on nonparametric correlation and regression analysis, 180 ERCPs would be necessary to achieve a free cannulation rate of 80% and 69 sphincterotomies to achieve a comfort level of 8 on a scale of 1 to 10. Thirty-six percent of fellows achieved the number of procedures and cannulation success determined by this study to indicate procedural competence. Sixty-four percent of fellows did not achieve procedural competence and 33% reported inadequate ERCP training. Nevertheless, 91% of fellows expected to perform unsupervised ERCP after training.

Conclusions:

The results of this study are consistent with those of previously published studies demonstrating that 160 to 200 ERCP procedures are necessary to achieve competence to perform ERCP. The majority of graduating fellows do not achieve an acceptable success rate during training, yet still intend to perform ERCP after training.

Section snippets

Patients and Methods

A brief questionnaire (Appendix) was sent in June 2001 to all gastroenterology fellowship programs in the United States. The questionnaire was sent by fax and e-mail to the Division of Gastroenterology administrative office listed in the journal Gastroenterology.3 The investigators asked that the questionnaire be forwarded to each of the graduating third-year fellows. The questionnaire consisted of 10 questions (Appendix). To maintain confidentiality and improve the response rate, fellows were

Results

Surveys were sent to 155 gastroenterology fellowship programs within the United States. A total of 69 third-year gastroenterology fellows responded. A median of 140 ERCPs was performed during 3 years of training, with a median of 35 sphincterotomies and an associated median comfort level for performing sphincterotomy of 7.5 on the scale of 1 to 10. The median estimated success of independent free cannulation was 75% (Table 1).

The relationship between the number of ERCPs performed and estimated

Discussion

Successful ERCP depends on the ability to achieve free cannulation of the desired duct, which relates to the number and frequency of ERCP procedures performed.6, 7 Endoscopists performing 25 or fewer ERCPs report only 38% success at bile duct cannulation as compared with 85% for endoscopists performing 200 procedures or more.8 At tertiary referral centers, where endoscopists perform a high volume of ERCPs, success rates of 95% or better are reported, even in patients who have previously

References (16)

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This study was an oral presentation at Digestive Diseases Week, San Francisco, California, May 19-22, 2002, San Francisco, California (Gastrointest Endosc 2002;55:AB77).

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