Endoscopic ultrasound-guided fine-needle aspiration skill acquisition of gastrointestinal submucosal tumor by trainee endoscopists: A pilot study.
Endoscopic ultrasound-guided fine-needle aspiration skill acquisition of gastrointestinal submucosal tumor by trainee endoscopists: A pilot study.
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DOI：
10.4103/2303-9027.183970
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发表时间：
2016-05
影响因子：
4.5
通讯作者：
Koike K
中科院分区：
文献类型：
--
作者：
Niimi K;Goto O;Kawakubo K;Nakai Y;Minatsuki C;Asada-Hirayama I;Mochizuki S;Ono S;Kodashima S;Yamamichi N;Isayama H;Fujishiro M;Koike K
内镜超声引导下细针穿刺活检（EUS-FNA）是一种有效的胃肠道粘膜下肿瘤（SMT）组织诊断方法，这些肿瘤难以通过标准内镜活检进行诊断。然而，学习曲线，特别是胃肠道SMT，尚未充分建立。本研究的目的是评估EUS-FNA对实习内镜医师胃肠道SMT的技能获得和诊断准确性，以阐明EUS-FNA的最佳起始标准。我们前瞻性评价了2010年5月至2014年3月期间51例胃肠道SMT的EUS-FNA手术。该手术由两名实习内窥镜医师和两名专家内窥镜医师执行。我们研究了EUS-FNA的诊断率以及与实习内镜医师和专家内镜医师之间准确性相关的因素。EUS-FNA组织学检查材料合格率为86.3%。虽然有2例（3.9%）发生感染，并进行了保守治疗，但未发现严重并发症。实习内镜医师与专家内镜医师相比，获得足够标本的比率无显著差异（76.5% vs. 82.3%，P = 0.4626）。然而，受训者的平均通过次数往往多于专家内镜医师（2.1次通过vs. 1.7次通过，P = 0.0511），并且病变位于胃的中间三分之一是受训者内镜医师非诊断性肿瘤的预测因素（P = 0.0075）。在EUS-FNA专家内镜医师的监督下，实习内镜医师可以安全地进行胃肠道SMT的EUS-FNA。
Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is an effective method for tissue diagnosis of gastrointestinal submucosal tumors (SMTs) that are difficult to diagnose by standard endoscopic biopsy. However, the learning curve, especially for gastrointestinal SMT, has not been sufficiently established. The aim of our study was to assess the skill acquisition and diagnostic accuracy of EUS-FNA for gastrointestinal SMT in trainee endoscopists in order to elucidate the optimal starting standards of EUS-FNA. We prospectively evaluated 51 EUS-FNA procedures for gastrointestinal SMT between May 2010 and March 2014. The procedure was performed by two trainee endoscopists and two expert endoscopists. We investigated the diagnostic yield of EUS-FNA and the factors associated with the accuracy between the trainee endoscopists and expert endoscopists. The rate of adequate EUS-FNA materials for histological examination was 86.3%. Although infections occurred in two cases (3.9%), which were managed conservatively, no severe complications were identified. Comparing the trainee endoscopists with expert endoscopists, there was no significant difference in the rate of gaining adequate specimen (76.5% vs. 82.3%, P = 0.4626). However, the mean number of passes of the trainees tended to be more than that of the expert endoscopists (2.1 pass vs. 1.7 pass, P = 0.0511), and lesions located in the middle third of the stomach were the predictive factors for nondiagnostic tumors by the trainee endoscopists (P = 0.0075). EUS-FNA for gastrointestinal SMT by trainee endoscopists can be safely performed under the supervision of EUS-FNA expert endoscopists.