Background/Objectives

The impact of competency-based training programs on pancreatic endoscopic retrograde cholangiopancreatography (ERCP) performance remains unclear. This study aimed to describe the learning curves of pancreatic ERCP and subsequent performance during independent practice.

Methods

This was a multicenter prospective cohort study involving advanced endoscopy trainees (AETs). In the 1st phase, trainees were assessed on every 5th ERCP using the ERCP and EUS Skills Assessment Tool (TEESAT). Cumulative sum (CUSUM) analysis of pancreatic ERCP evaluations was used to establish learning curves. During the 2nd phase (1st year of independent practice), now-graduated participants documented their performance on key ERCP quality indicators.

Results

A total of 24 AETs (20 training programs) received sufficient evaluations for CUSUM analysis. Pancreatic ERCP accounted for 14.6 % (196/1339) of all ERCPs evaluated with 45 % of pancreatic ERCPs carrying a Grade 3 level of complexity. A minority of AETs (16.7 %) performed enough pancreatic ERCPs to generate meaningful learning curves with no AETs achieving competence in pancreatic cannulation, sphincterotomy, or stone clearance during Phase 1. In Phase 2, a total of 3620 ERCPs were performed, of which 281 (7.8 %) were pancreatic ERCPs. While the overall pancreatic duct cannulation rate was 92.2 %, the native papilla pancreatic duct cannulation rate was 85.7 %, which was below the recommended 90 % threshold.

Conclusions

Advanced endoscopy training offers a low level of exposure to pancreatic ERCP, which is mirrored in independent practice, highlighting the inadequate training in pancreatic ERCP. Given the complexity of pancreatic ERCP, novel strategies are warranted to improve training in pancreatic ERCP.

中文翻译：

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在高级内窥镜培训期间有限地接触胰腺 ERCP 会影响独立实践的能力和表现

背景/目标

基于能力的培训计划对胰内镜逆行胰胆管造影（ERCP）表现的影响仍不清楚。本研究旨在描述胰腺 ERCP 的学习曲线以及独立实践中的后续表现。

方法

这是一项涉及高级内窥镜实习生 (AET) 的多中心前瞻性队列研究。在第一阶段，学员每 5 次接受 ERCP 评估，使用 ERCP 和 EUS 技能评估工具 (TEESAT)。胰腺 ERCP 评估的累积和 (CUSUM) 分析用于建立学习曲线。在第二阶段（独立实践的第一年），现已毕业的参与者记录了他们在关键 ERCP 质量指标方面的表现。

结果

总共 24 个 AET（20 个培训项目）获得了足够的 CUSUM 分析评估。胰腺 ERCP 占所有评估的 ERCP 的 14.6% (196/1339)，其中 45% 的胰腺 ERCP 具有 3 级复杂性。少数 AET (16.7%) 进行了足够的胰腺 ERCP 来生成有意义的学习曲线，但在第 1 阶段，没有 AET 达到胰腺插管、括约肌切开术或结石清除的能力。在第 2 阶段，总共进行了 3620 例 ERCP，其中 281 例(7.8%) 是胰腺 ERCP。虽然总体胰管插管率为 92.2%，但天然乳头胰管插管率为 85.7%，低于推荐的 90% 阈值。

结论

高级内窥镜培训对胰腺 ERCP 的接触程度较低，这在独立实践中得到了体现，凸显了胰腺 ERCP 培训的不足。鉴于胰腺 ERCP 的复杂性，需要采取新策略来改进胰腺 ERCP 培训。