Background and Aims

Previous studies on pediatric endoscopic training have not examined in detail if adverse events (AEs) are affected by the fellow’s training level. We aimed to determine whether trainee presence and educational level increase AEs or operative time (OT) for pediatric intestinal endoscopy.

Methods

This was a prospective observational study of AEs for all endoscopic procedures and retrospective analysis of OT (time of endoscope insertion until removal) for a sample of specified procedures at a tertiary children’s hospital. AEs were categorized by severity grades: 1, home management; 2, outpatient evaluation; 3, hospitalization and/or repeat endoscopy; 4, surgery and/or intensive care unit admission; and 5, death.

Results

A total of 15,886 procedures (6257 with trainee) including 1627 therapeutic procedures (733 with trainee) were analyzed for AEs. Four hundred thirteen total AEs (2.60%) and 213 AEs grade 2 to 4 (1.34%) were identified. Fellow presence at any training level did not increase AE rates for any procedures. Median OT for 3762 EGDs decreased from 17 to 11 minutes from the first quarter to the fourth quarter of first-year fellowship and then remained stable. EGDs without fellows were shorter (9 minutes, P < .0001) compared with any training level. Median times of 1291 colonoscopies with EGD decreased from 55 to 51 to 47 minutes for fellows in the first half, second half of first-year fellowship, and second and third year, respectively. Attendings alone were faster (37 minutes, P < .0001).

Conclusions

Current pediatric endoscopic training for is safe regardless of fellow training level. Trainee efficiency improves during and after fellowship.

中文翻译：

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同伴训练水平对普通小儿胃肠内镜手术不良事件和手术时间的影响

背景和目标

先前有关小儿内窥镜训练的研究尚未详细检查不良事件（AE）是否受该同伴的训练水平影响。我们旨在确定受训人员的存在和教育水平是否会提高小儿肠内窥镜检查的AEs或手术时间（OT）。

方法

这是对所有内窥镜检查程序进行的AE的前瞻性观察研究，并对三级儿童医院特定程序的样本进行了OT（内窥镜插入直至取出的时间）的回顾性分析。不良事件按严重性等级分类：1，家庭管理；2，门诊评价；3，住院和/或重复内镜检查；4，手术和/或重症监护室入院；5，死亡。

结果

总共对15886例程序（受训者6257）进行了分析，包括1627例治疗程序（受训者733）进行了不良事件分析。共鉴定出413例AE（2.60％）和213例2到4级（1.34％）AE。在任何培训水平上的资深会员都不会增加任何程序的AE率。第一年研究金的第一季度到第四季度，用于3762 EGD的OT中值从17分钟减少到11分钟，然后保持稳定。 与任何培训水平相比，没有同伴的EGD都更短（9分钟，P <.0001）。在上半年，第一年研究金的下半年，第二年和第三年中，有EGD的1291名结肠镜检查者的中位时间从55分钟减少到51分钟至47分钟。单独参加会议的速度更快（37分钟，P  <.0001）。

结论

无论同伴训练水平如何，目前的儿科内镜训练都是安全的。进修期间和进修后实习生的效率都会提高。