Department of Gastroenterology, The University of Tokyo, Tokyo, Japan; Center for Epidemiology and Preventive Medicine, The University of Tokyo, Tokyo, Japan.
Department of Gastroenterology, The University of Tokyo, Tokyo, Japan.
Endosc Ultrasound. 2016 May-Jun;5(3):157-64. doi: 10.4103/2303-9027.183970.
Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is an effective method for tissue diagnosis of gastrointestinal submucosal tumors (SMTs) that are difficult to diagnose by standard endoscopic biopsy. However, the learning curve, especially for gastrointestinal SMT, has not been sufficiently established. The aim of our study was to assess the skill acquisition and diagnostic accuracy of EUS-FNA for gastrointestinal SMT in trainee endoscopists in order to elucidate the optimal starting standards of EUS-FNA.
We prospectively evaluated 51 EUS-FNA procedures for gastrointestinal SMT between May 2010 and March 2014. The procedure was performed by two trainee endoscopists and two expert endoscopists. We investigated the diagnostic yield of EUS-FNA and the factors associated with the accuracy between the trainee endoscopists and expert endoscopists.
The rate of adequate EUS-FNA materials for histological examination was 86.3%. Although infections occurred in two cases (3.9%), which were managed conservatively, no severe complications were identified. Comparing the trainee endoscopists with expert endoscopists, there was no significant difference in the rate of gaining adequate specimen (76.5% vs. 82.3%, P = 0.4626). However, the mean number of passes of the trainees tended to be more than that of the expert endoscopists (2.1 pass vs. 1.7 pass, P = 0.0511), and lesions located in the middle third of the stomach were the predictive factors for nondiagnostic tumors by the trainee endoscopists (P = 0.0075).
EUS-FNA for gastrointestinal SMT by trainee endoscopists can be safely performed under the supervision of EUS-FNA expert endoscopists.
内镜超声引导下细针抽吸术（EUS-FNA）是一种有效的组织诊断方法，可用于通过标准内镜活检难以诊断的胃肠道黏膜下肿瘤（SMT）。然而，其学习曲线，尤其是对于胃肠道 SMT，尚未得到充分确立。我们的研究旨在评估受训内镜医师进行 EUS-FNA 诊断胃肠道 SMT 的技能习得和诊断准确性，以阐明 EUS-FNA 的最佳起始标准。
我们前瞻性评估了 2010 年 5 月至 2014 年 3 月期间进行的 51 例胃肠道 SMT 的 EUS-FNA 操作。该操作由两名受训内镜医师和两名专家内镜医师完成。我们调查了 EUS-FNA 的诊断率以及受训内镜医师和专家内镜医师准确性相关的因素。
进行组织学检查的 EUS-FNA 标本充足率为 86.3%。尽管有两例（3.9%）发生了感染，经保守治疗后得到了控制，但未出现严重并发症。与专家内镜医师相比，受训内镜医师获得充足标本的比例并无显著差异（76.5% vs. 82.3%，P = 0.4626）。然而，受训者的穿刺次数平均多于专家内镜医师（2.1 次 vs. 1.7 次，P = 0.0511），且受训者诊断为非诊断性肿瘤的预测因素为病变位于胃的中三分之一（P = 0.0075）。
在 EUS-FNA 专家内镜医师的监督下，受训内镜医师可安全地进行胃肠道 SMT 的 EUS-FNA。
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