Original ArticlesPerceptions of Gastroenterology Fellows Regarding ERCP Competency and 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)
- et al.
Endoscopic ultrasound and clinical competence
Gastrointest Endosc Clin N Am
(1995) - et al.
Regression by local fitting
Journal of Econometrics
(1988) - et al.
Success of ERCP at a referral center after a previously unsuccessful attempt
Gastrointest Endosc
(2000) - et al.
Complications of endoscopic retrograde cholangiopancreatography (ERCP). A study of 10,000 cases
Gastroenterology
(1976) - et al.
Assessment of technical competence during ERCP training
Gastrointest Endosc
(1996) - et al.
Quantitative assessment of procedural competence. A prospective study of training in endoscopic retrograde cholangiopancreatography
Ann Intern Med
(1996) Training and education in gastroenterology: list of available training programs
Gastroenterology
(2000)
Cited by (71)
Quality and competence in endoscopic retrograde cholangiopancreatography — Where are we 50 years later?
2018, Digestive and Liver DiseaseTraining pathways and competency assessment in endoscopic retrograde cholangiopancreatography
2017, Techniques in Gastrointestinal EndoscopyGuidelines for privileging, credentialing, and proctoring to perform GI endoscopy
2017, Gastrointestinal EndoscopyInternational consensus recommendations for difficult biliary access
2017, Gastrointestinal EndoscopyCitation Excerpt :It is reasonable to project that even more cases are needed to achieve competence in advanced procedures to tackle difficult cannulation (eg, precut papillotomy, pancreatic stent placement, EUS-guided biliary access, etc); future research is needed to better define the minimum volume/outcome requirements for these advanced procedures. However, a survey in the United Sates found that graduating fellows performed only a median of 140 ERCPs during training and 64% of those fellows did not achieve the recommended competency, but 91% planned to perform unsupervised ERCP after graduation.23 Low endoscopist ERCP volume (<25 per year) has been shown to be associated with a higher failure rate for ERCP and a greater need for post-ERCP hospitalization.24
When trainees reach competency in performing ERCP: A systematic review
2015, Gastrointestinal EndoscopyCitation Excerpt :Reasons for study exclusion are listed in Figure 1. With regard to the included studies, 5 were prospective in study design,7,12,16,18,19 7 assessed trainees with a gastroenterology background,7,12-15,17,19 and 2 assessed trainees with a general surgery background.16,18 Of note, 2 studies13,14 assessed the same study population; however, because they used different methodology for quantifying the procedural threshold, both were included.
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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).