Cass O W, Freeman M L, Peine C J, Zera R T, Onstad G R
Hennepin County Medical Center, Minneapolis, Minnesota.
Ann Intern Med. 1993 Jan 1;118(1):40-4. doi: 10.7326/0003-4819-118-1-199301010-00008.
To evaluate the number of supervised gastrointestinal endoscopic procedures required to achieve initial competency using a simple objective grading system.
Prospective, cross-sectional study.
A gastroenterology and surgical training program at a large, university-affiliated county hospital.
Seven gastroenterology fellows and five fourth-year surgery residents.
Trainees were graded postprocedure using a microcomputer program. Grading criteria for esophagogastroduodenoscopy included entering the esophagus (esophageal intubation), traversing the pylorus into the duodenum, and recognizing whether the upper gastrointestinal tract was abnormal. Criteria for colonoscopy were traversing the splenic flexure, intubating the cecum, and recognizing whether the colon was abnormal.
When presented with a case mix representative of practice, esophageal intubation did not reach 90% until more than 100 procedures had been done. Cecal intubation remained at only 84% after 100 procedures.
More than 100 supervised upper gastrointestinal endoscopies or colonoscopies are necessary to achieve technical competence in gastrointestinal endoscopy.
使用一种简单的客观评分系统评估达到初始操作能力所需的有监督的胃肠内镜检查操作数量。
前瞻性横断面研究。
一所大型大学附属医院的胃肠病学和外科培训项目。
7名胃肠病学进修医生和5名四年级外科住院医师。
使用微机程序在操作后对受训人员进行评分。食管胃十二指肠镜检查的评分标准包括进入食管（食管插管）、穿过幽门进入十二指肠以及识别上消化道是否异常。结肠镜检查的标准是穿过脾曲、插入盲肠以及识别结肠是否异常。
当面对一组代表实际情况的病例时，在进行了100多次操作后，食管插管成功率才达到90%。在进行100次操作后，盲肠插管成功率仅为84%。
要在胃肠内镜检查中达到技术熟练，需要进行100多次有监督的上消化道内镜检查或结肠镜检查。
