Download PDF
Endosc Int Open 2016; 04(12): E1286-E1291
DOI: 10.1055/s-0042-118176
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Learning curve for endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of pancreatic lesions in a novel ex-vivo simulation model

J. M. Gonzalez
1   Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
2   Department of Gastroenterology, North Hospital, Aix-Marseille University, AP-HM, Marseille, France
,
J. Cohen
1   Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
,
M. A. Gromski
3   Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, IN, USA
,
K. Saito
1   Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
,
A. Loundou
4   Department of Public Health, Medical Evaluation, Aix-Marseille University, AP-HM, Marseille, France
,
K. Matthes
5   Department of Anesthesiology, Kaiser Permanente Maui Memorial Medical Center, Wailuku, HI, USA
› Author Affiliations
Further Information

Publication History

submitted 06 April 2016

accepted after revision 13 September 2016

Publication Date:
15 December 2016 (online)

Also available at
    Permissions and Reprints

Background: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is essential in the management of digestive cancers. However, teaching and learning this technique remain challenging due to the lack of cost-effective models.

Material and methods: This was a prospective experimental study using a complete porcine upper gastrointestinal ex-vivo organ package, placed in an Erlangen Active Simulator for Interventional Endoscopy (EASIE-R), and prepared with one cyst and two solid masses (2 cm). Five fellows inexperienced in EUS-FNA were enrolled, performing 10 procedures on each lesion, alternatively. The total time, number of attempts for success, of needle view losses, and of scope handling were recorded, associated with an independent skills rating by procedure. We compared the first 15 procedures with the last 15 for each fellow.

Results: The fellows successfully performed all procedures in 2 to 40 minutes, requiring 1 to 6 attempts. All (5/5) improved their total time taken (P < 0.001), number of times when the EUS view of the needle was lost (P < 0.05), scope handling (P < 0.005), and skills rating (P < 0.001), whereas 4/5 (80 %) improved their number of attempts. The overall evaluation showed a significant decrease (P < 0.001) in the total time taken (11.2 ± 7.8 vs 4.3 ± 2.2 minutes), number of attempts (2.6 ± 1.2 vs 1.2 ± 0.7), number of times when the EUS view of the needle was lost (2.3 ± 2 vs 0.5 ± 0.7), and need for scope handling (1.1 ± 1.7 vs 0.1 ± 0.2). We also observed an improvement in skills rating (5 ± 1.9 vs. 7.7 ± 1.1).

Conclusion: This newly designed ex-vivo model seems to be an effective way to improve the initial learning of EUS-FNA, by performing 30 procedures.

Comment to this article:

Endoscopy International Open – recently publishedEndoscopy 2017; 49(02): 205-205
DOI: 10.1055/s-0042-124303

 

  • References

  • 1 Giovannini M. The place of endoscopic ultrasound in bilio-pancreatic pathology. Gastroenterol Clin Biol 2010; 34: 436-445
    CrossrefPubMedGoogle Scholar
  • 2 Săftoiu A, Vilmann P. Role of endoscopic ultrasound in the diagnosis and staging of pancreatic cancer. J Clin Ultrasound 2009; 37: 1-17
    CrossrefPubMedGoogle Scholar
  • 3 Giovannini M. Contrast-enhanced endoscopic ultrasound and elastosonoendoscopy. Best Pract Res Clin Gastroenterol 2009; 23: 767-779
    CrossrefPubMedGoogle Scholar
  • 4 Siddiqui AA, Tierney WM. The role of endoscopic ultrasound in the diagnosis and staging of pancreatic adenocarcinoma. J Okla State Med Assoc 2005; 98: 539-544
    PubMedGoogle Scholar
  • 5 Yoshinaga S, Suzuki H, Oda I et al. Role of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for diagnosis of solid pancreatic masses. Dig Endosc 2011; 23: 29-33
    CrossrefPubMedGoogle Scholar
  • 6 Hasan MK, Hawes RH. EUS-guided FNA of solid pancreas tumors. Gastrointest Endosc Clin N Am 2012; 22: 155-167 , vii
    CrossrefPubMedGoogle Scholar
  • 7 Barthet M. Endoscopic ultrasound teaching and learning. Minerva Med 2007; 98: 247-251
    PubMedGoogle Scholar
  • 8 Barthet M, Gasmi M, Boustiere C et al. EUS training in a live pig model: does it improve echo endoscope hands-on and trainee competence?. Endoscopy 2007; 39: 535-539
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 Rösch T. State of the art lecture: endoscopic ultrasonography: training and competence. Endoscopy 2006; 38: 69-S72
    Article in Thieme ConnectPubMedGoogle Scholar
  • 10 Savides TJ, Fisher AH, Gress FG et al. 1999 ASGE endoscopic ultrasound survey. ASGE Ad Hoc Endoscopic Ultrasound Committee. Gastrointest Endosc 2000; 52: 745-750
    CrossrefPubMedGoogle Scholar
  • 11 Klapman JB, Logrono R, Dye CE et al. Clinical impact of on-site cytopathology interpretation on endoscopic ultrasound-guided fine needle aspiration. Am J Gastroenterol 2003; 98: 1289-1294
    CrossrefPubMedGoogle Scholar
  • 12 Jenssen C, Möller K, Wagner S et al. [Endoscopic ultrasound-guided biopsy: diagnostic yield, pitfalls, quality management part 1: optimizing specimen collection and diagnostic efficiency]. Z Gastroenterol 2008; 46: 590-600
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Sorbi D, Vazquez-Sequeiros E, Wiersema MJ. A simple phantom for learning EUS-guided FNA. Gastrointest Endosc 2003; 57: 580-583
    CrossrefPubMedGoogle Scholar
  • 14 Matsuda K, Tajiri H, Hawes RH. How shall we experience EUS and EUS-FNA before the first procedure? The development of learning tools. Dig Endosc 2004; 16: 236-S239
    CrossrefPubMedGoogle Scholar
  • 15 Bhutani MS, Aveyard M, Stills HF. Improved model for teaching interventional EUS. Gastrointest Endosc 2000; 52: 400-403
    CrossrefPubMedGoogle Scholar
  • 16 Fritscher-Ravens A, Cuming T, Dhar S et al. Endoscopic ultrasound-guided fine needle aspiration training: evaluation of a new porcine lymphadenopathy model for in vivo hands-on teaching and training, and review of the literature. Endoscopy 2013; 45: 114-120
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Kim GH, Bang SJ, Hwang JH. Learning models for endoscopic ultrasonography in gastrointestinal endoscopy. World J Gastroenterol 2015; 21: 5176-5182
    CrossrefPubMedGoogle Scholar
  • 18 Maffei M, Dumortier J, Dumonceau J-M. Self-training in unsedated transnasal EGD by endoscopists competent in standard peroral EGD: prospective assessment of the learning curve. Gastrointest Endosc 2008; 67: 410-418
    CrossrefPubMedGoogle Scholar
  • 19 Chang KJ. EUS-guided FNA: the training is moving. Gastrointest Endosc 2004; 59: 69-73
    CrossrefPubMedGoogle Scholar
  • 20 Eloubeidi MA, Tamhane A. EUS-guided FNA of solid pancreatic masses: a learning curve with 300 consecutive procedures. Gastrointest Endosc 2005; 61: 700-708
    CrossrefPubMedGoogle Scholar
  • 21 Eisen GM, Dominitz JA, Faigel DO et al. Guidelines for credentialing and granting privileges for endoscopic ultrasound. Gastrointest Endosc 2001; 54: 811-814
    CrossrefPubMedGoogle Scholar
  • 22 Polkowski M, Larghi A, Weynand B et al. Learning, techniques, and complications of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Guideline. Endoscopy 2012; 44: 190-206
    Article in Thieme ConnectPubMedGoogle Scholar
  • 23 Meenan J, Harris K, Oppong K et al. Service provision and training for endoscopic ultrasound in the UK. Frontline Gastroenterol 2011; 2: 188-194
    CrossrefPubMedGoogle Scholar
  • 24 Matthes K, Cohen J. The Neo-Papilla: a new modification of porcine ex vivo simulators for ERCP training (with videos). Gastrointest Endosc 2006; 64: 570-576
    CrossrefPubMedGoogle Scholar
  • 25 Matthes K. Simulator training in endoscopic hemostasis. Gastrointest Endosc Clin N Am 2006; 16: 511-527 , viii
    CrossrefPubMedGoogle Scholar
  • 26 Hochberger J, Matthes K, Maiss J et al. Training with the compactEASIE biologic endoscopy simulator significantly improves hemostatic technical skill of gastroenterology fellows: a randomized controlled comparison with clinical endoscopy training alone. Gastrointest Endosc 2005; 61: 204-215
    CrossrefPubMedGoogle Scholar
  • 27 Maiss J, Wiesnet J, Proeschel A et al. Objective benefit of a 1-day training course in endoscopic hemostasis using the “compactEASIE” endoscopy simulator. Endoscopy 2005; 37: 552-558
    Article in Thieme ConnectPubMedGoogle Scholar
  • 28 Kato M, Gromski M, Jung Y et al. The learning curve for endoscopic submucosal dissection in an established experimental setting. Surg Endosc 2013; 27: 154-161
    CrossrefPubMedGoogle Scholar
  • 29 Mertz H, Gautam S. The learning curve for EUS-guided FNA of pancreatic cancer. Gastrointest Endosc 2004; 59: 33-37
    CrossrefPubMedGoogle Scholar