Jennifer Jorgensen

Radiation doses to ERCP patients are significantly lower with experienced endoscopists.

BACKGROUND Patients undergoing ERCP receive nontrivial doses of radiation, which may increase their risk of developing cancer, especially young patients. Radiation doses to patients during ERCP correlate closely with fluoroscopy time. OBJECTIVE The aim of this study was to determine whether endoscopist experience is associated with fluoroscopy time. DESIGN Retrospective analysis of a prospectively collected database. SETTING Data from 69 providers from 6 countries. PATIENTS 9,052 entries of patients undergoing ERCP. MAIN OUTCOME MEASUREMENTS Percent difference in fluoroscopy time associated with endoscopist experience and fellow involvement. RESULTS For procedure types that require less fluoroscopy time, compared with endoscopists who performed > 200 ERCPs in the preceding year, endoscopists who performed <100 and 100 to 200 ERCPs had 104% (95% confidence interval [CI], 85%-124%) and 27% (95% CI, 20%-35%) increases in fluoroscopy time, respectively. Every 10 years of experience was associated with a 21% decrease in fluoroscopy time (95% CI, 19%-24%). For fluoroscopy-intense procedures, compared with endoscopists who performed >200 ERCPs in the preceding year, endoscopists who performed <100 and 100 to 200 ERCPs had 59% (95% CI, 39%-82%) and 11% (95% CI, 3%-20%) increases in fluoroscopy time, respectively. Every 10 years of experience was associated with a 20% decrease in fluoroscopy time (95% CI, 18%-24%). LIMITATIONS Database used is a voluntary reporting system, which may not be generalizable. Data is self-reported and was not verified for accuracy. CONCLUSIONS Fluoroscopy time is shorter when ERCP is performed by endoscopists with more years of performing ERCP and a greater number of ERCPs in the preceding year. These findings may have important ramifications for radiation-induced cancer risk.

Is MRCP equivalent to ERCP for diagnosing biliary obstruction in orthotopic liver transplant recipients? A meta-analysis

BACKGROUND Biliary complications are the second leading cause of morbidity and mortality in orthotopic liver transplant (OLT) recipients. Endoscopic retrograde cholangiography (ERC) is considered the diagnostic criterion standard for post-orthotopic liver transplantation biliary obstruction, but incurs significant risks. OBJECTIVE To determine the diagnostic accuracy of MRCP for biliary obstruction in OLT patients. DESIGN A systematic literature search identified studies primarily examining the utility of MRCP in detecting post-orthotopic liver transplantation biliary obstruction. A meta-analysis was then performed according to the Quality of Reporting Meta-Analyses statement. SETTING Meta-analysis of 9 studies originally performed at major transplantation centers. PATIENTS A total of 382 OLT patients with clinical suspicion of biliary obstruction. INTERVENTIONS MRCP and ERCP or clinical follow-up. MAIN OUTCOME MEASUREMENTS Sensitivity and specificity of MRCP for diagnosis of biliary obstruction. RESULTS The composite sensitivity and specificity were 0.96 (95% CI, 0.92-0.98) and 0.94 (95% CI, 0.90-0.97), respectively. The positive and negative likelihood ratios were 17 (95% CI, 9.4-29.6) and 0.04 (95% CI, 0.02-0.08), respectively. LIMITATIONS All but 1 included study had significant design flaws that may have falsely increased the reported diagnostic accuracy. CONCLUSIONS The high sensitivity and specificity demonstrated in this meta-analysis suggest that MRCP is a promising test for diagnosing biliary obstruction in patients who have undergone liver transplantation. However, given the significant design flaws in most of the component studies, additional high-quality data are necessary before unequivocally recommending MRCP in this setting.

Small-bowel endoscopy core curriculum.

This is one of a series of documents prepared by the ASGE Training Committee. This curriculum document contains recommendations for training, intended for use by endoscopy training directors, endoscopists involved in teaching endoscopy, and trainees in endoscopy. It was developed as an overview of techniques currently favored for the performance and training of small-bowel endoscopy and to serve as a guide to published references, videotapes, and other resources available to the trainer. By providing information to endoscopy trainers about the common practices used by experts in performing the technical aspects of the procedure, the ASGE hopes to improve the teaching and performance of small-bowel endoscopy.

Training in Interventional Endoscopy: Current and Future State

Advanced or interventional endoscopy is not an Accreditation Council for Graduate Medical Education (ACGME) recognized fellowship. Historically, training for endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultraStates listed in Gastrointestinal Endoscopy, with 50 having 1 position per year, and 8 having 2 positions per year, resulting in the availability of 68 positions in 2015. The ASGE reports that the vast majority of these positions fill each year. For the past 2 years, there were slightly >100 applicants for approximately 65 positions. The American Board of Internal Medicine’s website lists about 520 fellows per year, which means that there are advanced endoscopy training positions for 13% of GI fellow graduates. The advantages of the ASGE “match” for advanced endoscopy training is that it has established fixed application, interview, and acceptance dates. It no longer creates the “early bird gets the worm” scenario, where application

EGD core curriculum

Richard S. Kwon, MD, Raquel E. Davila, MD, Daniel K. Mullady, MD, Mohammad A. Al-Haddad, MD, Ji Young Bang, MD, Juliane Bingener-Casey, MD, PhD, Brian P. Bosworth, MD, FASGE, Jennifer A. Christie, MD, Gregory A. Cote, MD, MS, Sarah Diamond, MD, Jennifer Jorgensen, MD, Thomas E. Kowalski, MD, Nisa Kubiliun, MD, Joanna K. Law, MD, Keith L. Obstein, MD, MPH, Waqar A. Qureshi, MD, FASGE, Francisco C. Ramirez, MD, Robert E. Sedlack, MD, MHPE, Franklin Tsai, MD, Shivakumar Vignesh, MD, Mihir S. Wagh, MD, FASGE, Daniel Zanchetti, MD, Walter J. Coyle, MD, Previous Committee Chair, Jonathan Cohen, MD, FASGE, Committee Chair