Iida Tomoya, Kaneto Hiroyuki, Wagatsuma Kohei, Sasaki Hajime, Naganawa Yumiko, Nakagaki Suguru, Satoh Shuji, Shimizu Haruo, Nakase Hiroshi
Department of Gastroenterology, Muroran City General Hospital, Japan.
Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Japan.
Intern Med. 2018 Apr 1;57(7):923-928. doi: 10.2169/internalmedicine.9737-17. Epub 2018 Feb 9.
Objective There are no reports on whether or not trainees can safely carry out endoscopic procedures for the removal of common bile duct (CBD) stones. The aim of this study was to investigate the efficacy and safety of endoscopic treatments for CBD stones by trainees. Methods Endoscopic retrograde cholangiopancreatography (ERCP) was performed in 1,016 consecutive patients at our institution during the 6-year study period. The endoscopically treated patients with CBD stones were included in this study. Physicians who had experienced ≥300 ERCP procedures were defined as experts, while those who had experienced <300 procedures were defined as trainees. The trainees were replaced by an expert when they could not achieve the established criteria. Patients were divided into the following three groups to retrospectively examine the patients' backgrounds, details of endoscopic treatments, and intra-/post-operative complications: Group A, completed by trainees under supervision of an expert; B, treated by an expert who switched in for a trainee in the middle of the procedure; and C, completed by an expert. Results A total of 325 patients with CBD stones underwent endoscopic treatments. The number included in Groups A, B, and C was 176, 102, and 47, respectively. The bile duct catheter insertion successes rates for Groups A, B, and C were 99.0%, 97.1%, and 100% (p=0.09), and the complete stone removal rates were 94.2%, 94.8%, and 100%, respectively (p=0.07), showing no significant difference among the three groups. Furthermore, the frequency of intra-/post-operative complications was not significantly different among the three groups (p=0.48, p=0.12, respectively). Conclusion This study showed that trainees could safely perform endoscopic procedures in accordance with our facility's criteria during ERCP.
目的 关于实习生能否安全地进行内镜下胆总管结石取出术，尚无相关报道。本研究旨在探讨实习生进行内镜下胆总管结石治疗的有效性和安全性。方法 在为期6年的研究期间，我们机构对1016例连续患者进行了内镜逆行胰胆管造影（ERCP）。本研究纳入了经内镜治疗的胆总管结石患者。经历过≥300例ERCP手术的医生被定义为专家，而经历过<300例手术的医生被定义为实习生。当实习生无法达到既定标准时，由专家取而代之。将患者分为以下三组，以回顾性研究患者背景、内镜治疗细节以及术中/术后并发症：A组，在专家监督下由实习生完成；B组，由在手术过程中替换实习生的专家进行治疗；C组，由专家完成。结果 共有325例胆总管结石患者接受了内镜治疗。A、B、C三组的病例数分别为176例、102例和47例。A、B、C三组的胆管导管插入成功率分别为99.0%、97.1%和100%（p = 0.09），结石完全清除率分别为94.2%、94.8%和100%（p = 0.07），三组之间无显著差异。此外，三组术中/术后并发症的发生率也无显著差异（分别为p = 0.48，p = 0.12）。结论 本研究表明，实习生在ERCP过程中能够按照我们机构的标准安全地进行内镜手术。
