Techniques in Gastrointestinal Endoscopy最新文献_第10页

Preface: A new era in training in advanced endoscopy 前言:先进内窥镜技术培训的新时代

Techniques in Gastrointestinal Endoscopy Pub Date : 2017-07-01 DOI: 10.1016/j.tgie.2017.08.002

Sachin Wani MD, FASGE (Guest Editor)

引用次数: 0

ED BOARD ED董事会

Techniques in Gastrointestinal Endoscopy Pub Date : 2017-07-01 DOI: 10.1016/S1096-2883(17)30068-2

引用次数: 0

Training pathways and competency assessment in endoscopic retrograde cholangiopancreatography 内窥镜逆行胰胆管造影的训练途径和能力评估

Techniques in Gastrointestinal Endoscopy Pub Date : 2017-07-01 DOI: 10.1016/j.tgie.2017.07.001

Eduardo Rodrigues-Pinto MD , Guilherme Macedo MD, PhD , Todd H. Baron MD

{"title":"Training pathways and competency assessment in endoscopic retrograde cholangiopancreatography","authors":"Eduardo Rodrigues-Pinto MD , Guilherme Macedo MD, PhD , Todd H. Baron MD","doi":"10.1016/j.tgie.2017.07.001","DOIUrl":"10.1016/j.tgie.2017.07.001","url":null,"abstract":"<div><p>Endoscopic retrograde cholangiopancreatography (ERCP) is one of the most technically demanding and high-risk procedures performed by gastrointestinal endoscopists. It requires significant focused training and experience to maximize success and to minimize poor outcomes. Ensuring competence in ERCP has recently emerged as an area of intense scrutiny as training programs and hospital credentialing committees attempt to approve, respectively, adequately trained endoscopists. Despite this, universally accepted standards for competence in ERCP have not been established. It is not a question of overall numbers, although we know that more is better. With the appreciation that different trainees develop endoscopic skills at different rates, there has been a shift toward competency-based training and certification. An assessment of individual performance is probably more robust than the use of minimum numbers for defining competence. It is still not clear what the exact measures should be and how to measure them, and no one has defined how trainee involvement in a procedure count as a “case” for the trainee. In this review, we sought to define ERCP competence, performance measures, quality indicators for training, maintenance of competency, and credentialing to help ensure that future ERCPists receive adequate quality and quantity of training to achieve procedural competency.</p></div>","PeriodicalId":43887,"journal":{"name":"Techniques in Gastrointestinal Endoscopy","volume":"19 3","pages":"Pages 117-124"},"PeriodicalIF":0.0,"publicationDate":"2017-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.tgie.2017.07.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43451309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 2

Cholangioscopy and pancreatoscopy 胆管镜和胰镜检查

Techniques in Gastrointestinal Endoscopy Pub Date : 2017-07-01 DOI: 10.1016/j.tgie.2017.09.001

Amrita Sethi MD , Raj J. Shah MD, FASGE, AGAF

引用次数: 9

Training in endoscopic submucosal dissection from a Western perspective 内镜下黏膜下剥离术的西方训练

Techniques in Gastrointestinal Endoscopy Pub Date : 2017-07-01 DOI: 10.1016/j.tgie.2017.08.001

Andrew Y. Wang MD , Peter V. Draganov MD

{"title":"Training in endoscopic submucosal dissection from a Western perspective","authors":"Andrew Y. Wang MD , Peter V. Draganov MD","doi":"10.1016/j.tgie.2017.08.001","DOIUrl":"10.1016/j.tgie.2017.08.001","url":null,"abstract":"<div><p><span><span>Endoscopic submucosal dissection (ESD) is a mature endoscopic procedure that was developed in Japan to enable the en bloc, curative resection of superficial dysplastic lesions in the luminal </span>gastrointestinal tract that have a low risk of </span>lymph node metastasis<span><span>. ESD requires a cognitive understanding of endosurgical principles, the ability to apply advanced optical imaging techniques to diagnose and stage lesions, and a high degree of endoscopic skill. Training in ESD should ideally begin with small lesions in the distal stomach, but such an approach is not applicable to endoscopists who are trying to learn and perform ESD in Western countries; as such, a “prevalence-based approach” is required that might vary from country to country. Proposed thresholds for attaining and maintaining competence in ESD, particularly for Western endoscopists, include rates of en bloc resection ≥80% and adverse events ≤10%. Endoscopists skilled in ESD should achieve rates of en bloc resection ≥90% and adverse events ≤5%. In order to offer ESD on a national level, a critical mass of endoscopists proficient in ESD is required who can then establish regional or national training centers and teach others with the requisite endoscopic skill and experience how to perform this elegant procedure. In the United States, ESD-specific billing codes are required to defray the procedural cost for </span>endoscopy<span> centers and health systems and to adequately compensate those endoscopists who offer this procedure as a life-saving alternative to more invasive surgical resection.</span></span></p></div>","PeriodicalId":43887,"journal":{"name":"Techniques in Gastrointestinal Endoscopy","volume":"19 3","pages":"Pages 159-169"},"PeriodicalIF":0.0,"publicationDate":"2017-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.tgie.2017.08.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48141130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 11

Training methods and assessment in endoscopic ultrasound 内窥镜超声的训练方法与评估

Techniques in Gastrointestinal Endoscopy Pub Date : 2017-07-01 DOI: 10.1016/j.tgie.2017.07.002

Dayna Early MD, Ricardo Badillo MD

{"title":"Training methods and assessment in endoscopic ultrasound","authors":"Dayna Early MD, Ricardo Badillo MD","doi":"10.1016/j.tgie.2017.07.002","DOIUrl":"10.1016/j.tgie.2017.07.002","url":null,"abstract":"<div><p>Endoscopic ultrasound (EUS) is a valuable diagnostic and therapeutic procedure widely available in the United States. Expanding indications for its use have led to an increased interest in performing the procedure and a demand for training opportunities among both experienced endoscopists and fellowship trainees. Training most commonly occurs in supervised, structured, hands-on settings, with competency being assessed using procedure numbers and subjective assessments. Other means of training are available but are recommended only as an adjunct to closely supervised training. Recently, methods for standardized assessment of procedural competency have been studied, and show that the absolute procedure numbers are a suboptimal method for assessing competency, and that trainees achieve competency at different rates. Published guidelines from national societies are available regarding competency and credentialing for EUS, and propose minimum case numbers before competency can be assessed. This article will focus on training pathways available in EUS, the most current national guidelines for competency assessment, a review of available evidence regarding competency assessment and learning curves for EUS trainees, and a review of the evolving quality indicators in EUS performance.</p></div>","PeriodicalId":43887,"journal":{"name":"Techniques in Gastrointestinal Endoscopy","volume":"19 3","pages":"Pages 110-116"},"PeriodicalIF":0.0,"publicationDate":"2017-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.tgie.2017.07.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43027858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Endoscopic eradication therapy in Barrett’s esophagus Barrett食管的内镜根除治疗

Techniques in Gastrointestinal Endoscopy Pub Date : 2017-07-01 DOI: 10.1016/j.tgie.2017.06.001

Swathi Eluri MD, MSCR, Nicholas J. Shaheen MD, MPH

{"title":"Endoscopic eradication therapy in Barrett’s esophagus","authors":"Swathi Eluri MD, MSCR, Nicholas J. Shaheen MD, MPH","doi":"10.1016/j.tgie.2017.06.001","DOIUrl":"10.1016/j.tgie.2017.06.001","url":null,"abstract":"<div><p><span><span>Endoscopic eradication therapy<span><span> (EET), the standard of care for treatment of Barrett’s esophagus with </span>dysplasia<span> and early neoplasia, consists of a combination of endoscopic resection and ablative modalities. Resection techniques primarily include </span></span></span>endoscopic mucosal resection<span><span> or endoscopic submucosal dissection. Resection of nodular disease is generally followed by one of multiple </span>ablative therapies among which </span></span>radiofrequency ablation has the best evidence supporting safety and efficacy. These advanced endoscopic procedures require both experience and expertise in the cognitive and procedural aspects of EET. However, very few formal programs exist that teach endoscopists the necessary skills to perform EET in a safe, standardized, and efficacious manner. Case volume at both the endoscopist and center level has been shown to affect clinical outcomes based on limited data. As a result, some recent guidelines endorse case volume as a measure of competency. Quality indicators, which can be used as benchmarks for training and as part of pay for quality initiatives, have recently been derived for EET. However, quality metrics in EET have not been widely accepted, nor are they broadly used currently. Although the efficacy of EET for BE is established, there is a need for application of quality metrics to both assure adequate training in these procedures and assess treatment outcomes. A standardized EET training curriculum during endoscopic training, with competency assessment of both new clinicians and endoscopists in practice, has the potential to improve care in EET.</p></div>","PeriodicalId":43887,"journal":{"name":"Techniques in Gastrointestinal Endoscopy","volume":"19 3","pages":"Pages 137-142"},"PeriodicalIF":0.0,"publicationDate":"2017-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.tgie.2017.06.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35681597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 7

Advanced imaging and therapeutic endoscopy 先进的成像和治疗性内窥镜检查

Techniques in Gastrointestinal Endoscopy Pub Date : 2017-07-01 DOI: 10.1016/j.tgie.2017.08.003

Chaitanya Pant MD, Mojtaba S. Olyaee MD, Amit Rastogi MD, FASGE

{"title":"Advanced imaging and therapeutic endoscopy","authors":"Chaitanya Pant MD, Mojtaba S. Olyaee MD, Amit Rastogi MD, FASGE","doi":"10.1016/j.tgie.2017.08.003","DOIUrl":"10.1016/j.tgie.2017.08.003","url":null,"abstract":"<div><p><span>From the early days of gastrointestinal endoscopy, there has been remarkable progress in imaging technology. High-definition </span>endoscopes<span><span><span> are now part of the standard armamentarium and a variety of other advanced imaging modalities jostle for space. However, the objective of each of these remains much the same; the enablement of the endoscopist to accurately characterize early gastrointestinal mucosal lesions, which are beyond the capability of standard devices. The benefit of doing so, may be manifold. First, during surveillance of gastrointestinal malignancy, the endoscopist may choose to eschew random biopsies in favor of targeted ones from areas of suspicious </span>mucosa<span>. Second, early mucosal lesions may be detected, which are typically amenable to endoscopic therapy. The ultimate result is improved clinical outcomes and in many cases, the avoidance of surgery. The goal of this review is to summarize for the reader, the most important technologies in advanced </span></span>endoscopic imaging and their applicability to clinical practice with emphasis on their functioning, implementation, and effect on therapeutic endoscopy.</span></p></div>","PeriodicalId":43887,"journal":{"name":"Techniques in Gastrointestinal Endoscopy","volume":"19 3","pages":"Pages 151-158"},"PeriodicalIF":0.0,"publicationDate":"2017-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.tgie.2017.08.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47022212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 2

Management of bleeding ectopic varices 异位静脉曲张破裂出血的处理

Techniques in Gastrointestinal Endoscopy Pub Date : 2017-04-01 DOI: 10.1016/j.tgie.2017.03.007

Zachary H. Henry MD, MS, Stephen H. Caldwell MD

{"title":"Management of bleeding ectopic varices","authors":"Zachary H. Henry MD, MS, Stephen H. Caldwell MD","doi":"10.1016/j.tgie.2017.03.007","DOIUrl":"10.1016/j.tgie.2017.03.007","url":null,"abstract":"<div><p><span><span>Ectopic varices (ECV) are a heterogeneous group of portosystemic shunts that occur in the presence of </span>portal hypertension<span>. The shunts occur throughout the abdomen and pelvis, including the gallbladder, the genitourinary system, and the </span></span>retroperitoneal space<span>, but they are most common within the bowel (small intestine and colon) and at the mucocutaneous junction of a stoma. Bleeding rates vary depending on the location, but overall, ECV account for 1%-5% of all variceal bleeding and can lead to significant morbidity and mortality. Management of these shunts can be very difficult owing to complex underlying vascular anatomy. Although there is a role for endoscopic intervention in these cases, definitive therapy by this modality is often unachievable, necessitating complex endovascular procedures to ultimately occlude the shunt. Understanding the anatomy, the reported success rates with various procedural interventions, and the complications of those interventions is of the utmost importance in the management of ECV and will be reviewed here in detail.</span></p></div>","PeriodicalId":43887,"journal":{"name":"Techniques in Gastrointestinal Endoscopy","volume":"19 2","pages":"Pages 101-107"},"PeriodicalIF":0.0,"publicationDate":"2017-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.tgie.2017.03.007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48411504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 15

Endoscopic management of acute esophageal variceal bleeding 急性食管静脉曲张出血的内镜治疗

Techniques in Gastrointestinal Endoscopy Pub Date : 2017-04-01 DOI: 10.1016/j.tgie.2017.03.002

Sheeva K. Parbhu MD, Douglas G. Adler MD, FACG, AGAF, FASGE

引用次数: 1