Video 28.1 Heater probe
Video 28.2 Through-the-scope clip.
Video 28.3 OverStitch
Video 28.4 Over-the-scope with anchor.
Video 32.1 Ampullectomy simple.
Video 32.2 Ampullectomy intraductal recurrence.
Video 32.3 Duodenal adenoma DDW 2012 final video.
Video 32.4 Ampullectomy post fully covered SEMS.
Video 32.5 Ampullectomy post second SEMS.
Video 32.6 Duodenal polyp EMR hem.
Video 32.7 Endoscopic mucosal resection of a large duodenal polyp.
Video 34.1 Post glue injection for fundic varix.
Video 34.2 Large sized esophageal varices with spurting gastric extension.
Video 34.3 One-week follow-up post-banding for esophageal varices.
Video 34.4 Glue injection of gastric extension of esophageal va rices by retrograde approach.
Video 34.5 A case of bleeding esophageal varices with concomit ant gastric varices.
Video 34.6 Using new technology as NBI, I-scan and FICE for detection of the Z-line.
Video 35.1 A high confidence conventional adenoma examined with narrow band imaging.
Video 35.2 Cancer arising from a conventional adenoma.
Video 35.3 A white submucosal chord after cold snare resection of a small polyp.
Video 35.4 A large sessile serrated polyp with foci of cytological dysplasia.
Video 35.5 Large serrated lesion demonstrates features of sessile serrated polyps in the WASP classification.
Video 42.1 Photodynamic Therapy
Video 43.1 Endoscopic treatment for chronic pancreatitis.
Video 43.2 Endoscopic ultrasound guided drainage.
Video 44.1 Endoscopic Ultrasound-Fine-Needle Aspiration of a pancreatic mass.
Video 44.2 Cysto-gastrostomy and axios stent deployment of a pseudocyst.
Video 44.3 Endoscopic Ultrasound-Fine-Needle Aspiration of a mucinous cystic neoplasm containing viscous, thick mucin.
Video 44.4 Endoscopic Ultrasound-Fine-Needle Aspiration guide alcohol ablation therapy of a mucinous neoplasm.
Section I
Introduction to Endoscopy
1 Education and Training in Endoscopy
2 The Value of Clinical Research
1 Education and Training in Endoscopy
Jürgen Hochberger, Jürgen Maiss, and Jonathan Cohen
1.1 Introduction
Optimal patient care and quality outcomes are becoming increasingly important in clinical medicine. Specialist medical societies have produced guidelines and recommendations for minimum quality requirements for performance of endoscopic techniques (
Recently, endoscopy simulators have rekindled debate on whether training in basic manual skills is better provided outside the patient.4,5,6,7,8 Despite the growing availability of various training models, practical skills are still routinely acquired by performing actual procedures under the supervision of a senior endoscopist. This chapter presents an overview of training issues and the role of simulators in training.
1.2 Clinical Education
A few general principles can be applied to the entire field of endoscopic training:
• The endpoint of training is the acquisition of competency to perform the examinations without supervision at a level comparable to that achieved by practitioners in the community.
• While certain general endoscopic basic skills are crucial to many procedures, training must be procedure specific. Competency in one technique does not necessarily guarantee competency in another technique.
• Procedures performed for diagnostic purposes should also enable related tissue sampling or therapies associated with that procedure.
1.2.1 Clinical Training to Competency in Esophagogastroduodenoscopy and Colonoscopy: Studies, Guidelines, and Assessment
Since the early 1980s, trainees have been required to keep a record of all procedures performed,1 in particular for colonoscopy. The ability to reach the cecum is the most common criterion by which colonoscopies have been judged.9 Data from early studies showed variable learning curves and led to the concept of minimal numbers of procedures required.1 Sedlack et al presented in 2011 a new assessment tool, the so-called Mayo Colonoscopy Skills Assessment Tool (MCSAT), to describe learning curves for colonoscopy.10 They evaluated forty-one GI fellows who performed 6,635 colonoscopies. Independent cecal intubation rates of 85% and cecal intubation times of 16 minutes or less were achieved at 275 procedures on average, which is more than previous gastroenterology training recommendations required.
In 2014, the Training Committee of the American Society for Gastrointestinal Endoscopy (ASGE) presented the “Assessment of Competency in Endoscopy” (ACE) tool as a refinement of the MCSAT.9 The ACE tool added important quality parameters such as a metric assessment of fine-tip control and polyp detection rates. In 2016, a prospective, multicenter trial was published evaluating the ACE tool at 10 institutions across the United States including 93 gastrointestinal (GI) fellows.11 A total of 184 senior endoscopists assessed 1,061 colonoscopies, which included 6 motor and 6 cognitive skills on a 4-point scale. The average fellow reached required cognitive and motor skills endpoints by 250 procedures, with over 90% of fellows surpassing these thresholds by 300 procedures.11 Procedure times, polyp detection rates, and polyp miss rates with increasing experience are shown in