Miutescu Bogdan, Dhir Vinay
Department of Gastroenterology and Hepatology, "Victor Babeş" University of Medicine and Pharmacy, Timisoara, Romania.
Institute of Digestive and Liver Care, SL Raheja Hospital, Mumbai, India.
Dig Endosc. 2025 Jan;37(1):40-50. doi: 10.1111/den.14881. Epub 2024 Jul 17.
Endoscopic ultrasound (EUS) has transformed the landscape of minimally invasive gastrointestinal procedures, necessitating specialized training for proficiency in interventional EUS (iEUS). This study evaluates the effectiveness of iEUS training, focusing on learning curves, success rates, and the associated risks in various procedures, aiming to recommend practices for standardizing training and ensuring competency. Key metrics such as procedure type, learning curve for proficiency, success rates, and risk of adverse events were analyzed to establish benchmarks for training programs. Proficiency in pancreatic fluid collection drainage was achieved after 20-30 procedures, with a 100% success rate and a complication rate ranging from 1.5 to 80%. Gallbladder drainage required 19 cases to reach an 86% success rate, with adverse events reported in 19% of cases. Choledocoduodenostomy mastery was observed after approximately 100 cases, with postintervention pancreatitis affecting 5.3-6.6% of all cases. Hepaticogastrostomy showed a 93% success rate after 33 cases, with a 24.8% adverse event rate. Hepaticoenterostomy reached 100% success beyond the 40th patient, with a 20% rate of postsurgical strictures. Pancreatic duct drainage achieved 89% technical and 87% clinical success after 27 cases, with 12-15% adverse events. Gastro-enteric anastomosis required 25 cases for proficiency and approximately 40 cases for mastery, with 5.5% immediate and 1% late adverse events. iEUS training outcomes vary significantly across different procedures, highlighting the importance of structured, procedure-specific training programs to achieve proficiency. These findings provide a foundation for developing universal competency benchmarks in iEUS, facilitating consistent and effective training worldwide.
内镜超声（EUS）已经改变了微创胃肠道手术的格局，这就需要进行专门培训，以熟练掌握介入性EUS（iEUS）。本研究评估了iEUS培训的有效性，重点关注学习曲线、成功率以及各种手术相关风险，旨在推荐标准化培训和确保能力的实践方法。分析了手术类型、熟练掌握的学习曲线、成功率和不良事件风险等关键指标，以建立培训项目的基准。胰腺液体收集引流在进行20 - 30例手术后达到熟练水平，成功率为100%，并发症发生率在1.5%至80%之间。胆囊引流需要19例才能达到86%的成功率，19%的病例报告有不良事件。胆总管十二指肠吻合术在大约100例手术后达到熟练掌握，干预后胰腺炎影响所有病例的5.3 - 6.6%。肝胃吻合术在33例手术后成功率为93%，不良事件发生率为24.8%。肝肠吻合术在第40例患者之后成功率达到100%，术后狭窄发生率为20%。胰腺导管引流在27例手术后技术成功率为89%，临床成功率为87%，不良事件发生率为12 - 15%。胃肠吻合术熟练掌握需要25例，精通需要约40例，即时不良事件发生率为5.5%，迟发性不良事件发生率为1%。iEUS培训结果在不同手术中差异显著，突出了结构化、针对特定手术的培训项目对于达到熟练水平的重要性。这些发现为制定iEUS通用能力基准提供了基础，有助于在全球范围内进行一致且有效的培训。
