Maffei Massimo, Dumortier Jérôme, Dumonceau Jean-Marc
Geneva University Hospitals, Geneva, Switzerland.
Gastrointest Endosc. 2008 Mar;67(3):410-8. doi: 10.1016/j.gie.2007.07.024. Epub 2007 Dec 26.
Training programs in unsedated transnasal (UT) EGD are scarce.
To prospectively assess the learning curve for unsupervised UT-EGD.
Endoscopy service, without experience in UT-EGD.
Consecutive patients referred for diagnostic EGD.
UT-EGD was attempted in 140 study patients by 2 endoscopists who trained by themselves in UT-EGD (skilled endoscopist [n = 70]; a trainee having recently achieved competency in conventional EGD [n = 70]) and in 10 controls (endoscopist skilled in UT-EGD) by using a 4.9-mm-diameter videoendoscope.
Technical success, sedation administered, patient tolerance acceptance, procedure duration for each decade of 10 consecutive patients investigated by the same endoscopist; intention-to-treat analysis.
Both self-trained endoscopists fulfilled predefined criteria of competency in UT-EGD since the first attempts. They completed examinations of adequate quality with exclusive transnasal scope insertion (n = 139 [99.3%]), no sedation (n = 138 [98.6%]), and patient accepting repeat procedure (n = 135 [96.4%]) in proportions not significantly different from controls for all decades. Compared with a median procedure duration of 5.5 minutes (interquartile range [IQR] 5.0-8.5 minutes) in controls, procedures were significantly longer for all trainee's decades (eg, first decade 20.0 minutes [IQR 15.0-29.0 minutes], P < .001) but none for the skilled endoscopist. Overall discomfort, pain, gagging, and belching were not significantly different for study patients versus controls. Fifty-six of 69 study patients (81%) with a previous history of conventional EGD preferred UT-EGD.
Generalizability to other small-caliber endoscopes.
Endoscopists competent in conventional EGD may obtain excellent results with UT-EGD (except for procedure duration) beginning with their first attempts, even without supervision or structured training.
非镇静经鼻（UT）电子胃镜检查的培训项目很少。
前瞻性评估无监督UT-EGD的学习曲线。
内镜检查服务机构，无UT-EGD经验。
连续转诊进行诊断性EGD的患者。
2名内镜医师对140例研究患者尝试进行UT-EGD，这2名医师均自行接受UT-EGD培训（熟练内镜医师[n = 70]；最近在传统EGD方面达到胜任水平的实习生[n = 70]），并对10名对照者（熟练掌握UT-EGD的内镜医师）使用直径4.9毫米的视频内镜进行检查。
技术成功率、给予的镇静情况、患者耐受性接受程度、同一名内镜医师连续检查的每10例患者每一组的操作时长；意向性分析。
两名自行培训的内镜医师从首次尝试起就达到了UT-EGD的预定义胜任标准。他们完成了质量合格的检查，完全经鼻插入内镜（n = 139 [99.3%]），未使用镇静剂（n = 138 [98.6%]），患者接受重复检查（n = 135 [96.4%]），在所有组中这些比例与对照组相比无显著差异。与对照组操作时长中位数5.5分钟（四分位间距[IQR] 5.0 - 8.5分钟）相比，所有实习生组的操作都明显更长（例如，第一组20.0分钟[IQR 15.0 - 29.0分钟]，P < .001），但熟练内镜医师组没有。研究患者与对照组相比，总体不适、疼痛、恶心和嗳气情况无显著差异。69例有传统EGD既往史的研究患者中有56例（81%）更喜欢UT-EGD。
对其他小口径内镜的可推广性。
即使没有监督或结构化培训，熟练掌握传统EGD的内镜医师从首次尝试UT-EGD开始（除操作时长外）也可获得优异结果。
