Оглавление
Группа авторов. Successful Training in Gastrointestinal Endoscopy
Table of Contents
List of Tables
List of Illustrations
Guide
Pages
Successful Training in Gastrointestinal Endoscopy
List of Contributors
Foreword
Preface
Acknowledgments
About the Companion Website
1 Training in Endoscopy: A Historical Background
Introduction
Standard training in endoscopy: then and now
What must be learned?
Standards and end points of current endoscopic training
Emergence of complementary teaching modalities. Why use simulators?
Evolution and types of endoscopy simulators. Static models
Ex vivo artificial tissue models: the “Phantom” Tübingen models
Ex vivo animal tissue simulators: Erlanger and EASIE models
Live animal courses
Computer simulation
The future of simulators in endoscopy training
Ongoing evolution of endoscopic training
A peek into the future of endoscopic training to 2030
Conclusion
Videos
References
2 How Endoscopy is Learned: Deconstructing Skill Sets
Introduction
Identification of fundamental endoscopy skills
Introduction of the scope
Navigation
Overcoming obstacles
Inspection
Instrumentation
Simulators and task deconstruction
Summary
Videos
References
3 Training to Become a High‐Quality Endoscopist: Mastering the Nonprocedural Aspects
Preprocedure
Informed consent
Exceptions to informed consent
Informed refusal
Lack of informed consent
Documentation
Preoperative clinical assessment: focused history and physical exam
Intraprocedure
Postprocedure
Documentation of procedure
Feedback to referring provider
Recognition of complications
Patient satisfaction
Medicolegal issues
Elements of malpractice
Training in quality assurance and improvement
Conclusion
References
4 Training the Endoscopic Trainer
Introduction
Training environment
Attributes of effective endoscopy trainers
Framework for endoscopic training
Preparation
Training
Wrap‐up
Summary
Training aids
Magnetic imagers
Endoscopic simulators
Train‐the‐trainer programs
Conclusions
References
5 Esophagogastroduodenoscopy (EGD)
Introduction to EGD training. Need for training
Format of training
Requirements for EGD training. Trainee
Trainer
Setting
EGD training. Cognitive aspects. Indication for the EGD
Administration of moderate sedation
Landmark and pathology recognition
Technical aspects
Equipment
Diagnostic endoscopy. Patient positioning
Handling of the endoscope (Video 5.1)
Esophageal intubation (Video 5.2)
Examination of the esophagus and stomach
Examination of the duodenum (Video 5.4)
Routine tissue biopsy (Video 5.5)
Therapeutic endoscopy. Management of bleeding ulcers
Variceal ligation
Stricture dilation
PEG tube placement
Stenting
Advanced endoscopic resection and endoscopic submucosal dissection
Alternatives for EGD training: simulator‐based training
Computer simulators
Animal models
Assessment of performance
Conclusions
Videos
References
Note
6 Colonoscopy
Introduction
Specific skills
Early skills. Early cognitive skills
Anatomy
Basics of endoscopic anatomy
Preparation
Scope selection
Sedation
Indication/contraindications
Early motor skills. How to hold scope
Scope dials
Scope valves
Scope insertion
Scope advancement
Tip control
Torque
Scope advancement techniques
Lumen identification
Air and water during scope advancement
Withdrawal/inspection
Intermediate skills
Intermediate cognitive skills. Pathology recognition
Device selection and settings
Complication management
Intermediate motor skills. Loop reduction
Angulated turns
Ileocecal valve
How to teach and assess colonoscopy skills
Early cognitive skills
Early motor skills
Intermediate cognitive skills
Intermediate motor skills
Ongoing assessment
Videos
References
7 Endoscopic Ultrasound
EUS requires different skill sets than standard endoscopy
Learning resources for EUS
The skill sets needed to learn EUS
Anatomy
Understand diseases and conditions assessed with EUS
Ultrasound principles
EUS image interpretation
How to operate EUS equipment
Use of EUS scope
Diagnostic EUS imaging
EUS‐guided fine‐needle aspiration (FNA)
EUS FNA cytologic evaluation
Interventional EUS
Report generation and communication with referring physicians
Pathways for EUS training
EUS fellowship training
EUS training for established practitioners
Barriers to EUS training
Complementary training options. Simulators
Assessing EUS quality performance
Conclusion
Video
References
8 ERCP
Introduction to ERCP training. The need for training
The format of training
The types of training—from clinical to simulation
Prerequisite for training. Trainee—level of skill and expertise
Setting—case load
Trainer—a skilled endoscopist may not be a good teacher
Advice for trainers
ERCP training. Cognitive and technical aspects
Equipment—scope, accessories, and diathermy
Accessories can be separated into diagnostic and therapeutic categories
Performance—key steps to technique and trick of trade. Scope handling
Cannulation—selective
Advanced techniques to overcome difficult biliary cannulation
Precutting with the (regular) wire‐guided papillotome along the biliary axis
Precutting with regular papillotome positioned in pancreatic axis/duct (septostomy)
Precutting with needle knife alongside an indwelling pancreatic stent
Fistulotomy with needle knife
Papillotomy—standard
Stone extraction—balloon and basket
Stenting—plastic and metal
Stent length measurement
Guide wire negotiation of bile duct stricture
Dilation of stricture
Brush cytology
Stent placement
Short‐wire system
Multiple stents insertion
Pancreatic stenting
Special accessories—mechanical lithotripter
Alternatives for ERCP training. Setting and tools—traditional, caseload, simulator training (comparison)
Comparison of the different simulators for ERCP practice
Impact of supplemental simulator training
Assessment of performance
Training and clinical outcome correlation
How much volume is needed to maintain skill—retraining and new techniques
The role of the assistant
Conclusion
Videos
References
9 Capsule Endoscopy
Introduction
Description of the capsules
The capsule endoscopy unit
Preparing the patient
Administering the capsule
Capsule endoscopy reading in clinical settings
Reading capsule endoscopy study
Credentialing the capsule endoscopist: current guidelines
Training the capsule endoscopist: current literature
Future directions
Conclusions
Videos
References
10 Deep Enteroscopy
Introduction
Prerequisites for training in deep enteroscopy. Trainee
Trainers
Setting
Cognitive component of deep enteroscopy. Indications
Bowel preparation
Sedation
Equipment for deep enteroscopy. Endoscopes
Overtubes and balloons
Endoscopic accessories
Technical aspects of enteroscopy training
Advancement technique(s)
Therapeutic enteroscopy maneuvers. Hemostasis
Polyp resection
Stricture dilation
ERCP and enteral stent placement in the setting of altered anatomy
Recognition of complications
Ex vivo training models
Achieving competence
Conclusion
Videos
References
11 Cholangioscopy and Pancreatoscopy
Introduction
Technique of cholangiopancreatoscopy
Indications for cholangioscopy
Cholangioscopy for the characterization of biliary lesions and strictures
Biliary stricture
Differentiating malignant from benign biliary stricture
Cholangioscopy‐guided stone therapy
Cholangioscopy‐guided selective cannulation
Indications for cholangioscopy without fluoroscopy
Cholangioscopy in therapy of malignant bile duct lesions
Contraindications to cholangioscopy
Complications of cholangioscopy
Peroral direct cholangioscopy
Methods for cannulation for PDCS
Wire‐guided method
Balloon‐anchoring method
Utilities of the ultraslim upper endoscope
Pancreatoscopy
Pancreatoscopy for intraductal papillary mucinous neoplasm
Pancreatoscopy in chronic pancreatitis
Intraoperative pancreatoscopy
Complications of pancreatoscopy
Trainee prerequisites
Trainer and facility prerequisites
Steps to learn
Competency
Summary
Videos
References
12 Principles of Electrosurgery
Introduction
Basics of electricity as applied to electrosurgery
Monopolar and bipolar circuits
Safety measures in electrosurgery. The return electrode
Pacemakers
Neuromuscular stimulation
Explosion risk
Current leaks
Tissue effects of electrosurgery in endoscopy
Cutting
Coagulation
Combination cutting and coagulation
Clinical applications of electrosurgery in endoscopy. Resection techniques
Incision techniques
Bipolar techniques
Argon plasma coagulation (APC) (Figure 12.12)
Incorporation of electrosurgical principles into endoscopy training
References
13 Training in the Use of Fluoroscopy for Gastrointestinal Endoscopy
Introduction
Training in fluoroscopy
Hardware basics
Protective garments
Scout films
ERCP
Fluoroscopy and enteral stents
Esophageal stents
Submucosal radiocontrast dye injection
Endoscopic clips as markers
External markings
Gastroduodenal stents
Colon stents
Enteroscopy
Push enteroscopy
Single‐ and double‐balloon enteroscopy
Lumen‐apposing metal stents (LAMS)
Conclusion
References
14 Training in Pediatric Endoscopy
Introduction
Training program requirements
Esophagogastroduodenoscopy and colonoscopy
Patient assessment
Informed consent
Sedation
Sedation for pediatric endoscopy procedures: when not to use it
Cognitive aspects of training in sedation
Technical aspects of training in sedation
Topical agents
Benzodiazepines
Narcotics
Ketamine
Propofol
Reversal agents for pediatric sedation
Upper endoscopy
Technical skills
Instruments
Colonoscopy
Cognitive skills
Technical skills
Instruments
Diagnostic techniques in upper endoscopy and colonoscopy
Identifying pathology
Therapeutic procedures in pediatric endoscopy. Foreign body removal
Percutaneous endoscopic gastrostomy (PEG)
Contraindications
Complications
Stricture dilation
Management of GI bleeding
Injection therapy
Thermal coagulation
Mechanical therapy
Band ligation
The role of adult endoscopists in pediatrics
Defining and assessing procedural competency
Assessing competency
Simulation in pediatric endoscopy
Advanced procedures
Endoscopic retrograde cholangiopancreatography (ERCP)
Endoscopic ultrasound
Wireless video capsule endoscopy
References
15 Contrast‐Enhanced Endoscopy: Chromo and Optical Contrast Techniques
Introduction
Overview of contrast (image)‐enhancement techniques: chromoendoscopy and other optical techniques
Chromoendoscopy
Chromoendoscopy in inflammatory bowel disease
Chromoendoscopy in esophageal neoplasia
Chromoendoscopy for colorectal polyps and nonpolypoid neoplasia
Narrowband imaging
NBI in Barrett's esophagus
NBI for colorectal polyp detection
NBI in inflammatory bowel disease
NBI for classification of colorectal neoplasia
FICE, BLI, BLI‐Bright, LCI, and iScan
Fluorescence imaging
Confocal laser endomicroscopy
Molecular imaging
Methods for training in contrast‐enhanced endoscopy techniques
Evidence for effect of training
Summary
Videos
References
16 Training in GI Hemostasis
Introduction
Prerequisite cognitive knowledge required prior to learning GI endoscopic hemostatic techniques
Prerequisite technical knowledge and skills required to learn endoscopic hemostasis
Required technical knowledge and skills to be proficient in endoscopic hemostasis
Common knowledge and skills for all hemostatic strategies. Knowledge
Skill
Specific hemostatic strategies. Injection. Knowledge
Skill
Thermal. Knowledge
Skill
Mechanical. Knowledge
Skill
Simulators to learn and practice endoscopic hemostasis
Available models of endoscopic hemostasis. Virtual reality simulators
In vivo large animal models of upper GI hemorrhage
Ex vivo models of GI hemorrhage
Teaching in endoscopic hemostasis. Key components of hemostasis to teach
Data supporting the role of hemostasis training on simulators
Learning progress in endoscopic hemostasis
Concept of integrating simulator work into standard endoscopy training
Maintaining skills in endoscopic hemostasis
Additional teaching aides for learning GI hemostasis
Limitations of GI endoscopy for diagnosis and hemostasis of GI bleeding: teaching pearls for troubleshooting and challenges for the future
Definition of minimal thresholds for determining competency in endoscopic hemostasis
Requirements to maintain endoscopic hemostasis skills
Ongoing challenges in learning new GI hemostasis techniques or improving skills
Summary
Acknowledgment
Videos
References
17 Luminal Dilation Techniques (Strictures, Achalasia, Anastomotic, IBD)
Introduction
Equipment
Fixed‐diameter push‐type or “bougie” dilators
Balloon dilators
Differences between fixed‐diameter push‐type and balloon dilators
Ancillary devices
Endoscope key points to remember
Fluoroscopy
Mechanism of dilation
Terminology
Simple stricture
Complex stricture
Refractory or recurrent stricture (esophagus)
Technique of dilation
Fixed‐diameter push‐type or “bougie” dilation
TTS balloon dilation
Continuous access technique
Maloney dilators
Dilator selection
Goal
Ancillary techniques
Contraindications
Complications
Some key points
Achalasia
Endoscopy and performance of pneumatic balloon dilation in achalasia
Suggested skill set to master and potential outcome measures to assess proficiency in performing luminal dilation. Skills to master
Measurable outcomes for instructor to assess while working with trainee
For push‐type dilation
For balloon dilation
For achalasia
Suggested skill level to perform dilation
Basic
Advanced
Videos
References
18 Management of Foreign Body Ingestion and Esophageal Food Bolus Obstruction
Introduction
Training in FB extraction
Pre‐procedure assessment
Identify devices. Protective instruments
Retrieval instruments
Anticipate the endoscopy
Endoscopic removal
Further evaluation
Conclusions
Videos
References
19 Endoscopic Mucosal Resection, Submucosal Dissection, and Full Thickness Resection Techniques
Introduction
Endoscopic mucosal resection. EMR techniques to be considered. Common EMR techniques according to organs
Special EMR techniques not considered
Procedures to be considered
Prerequisite level of expertise for endoscopic mucosal resection (EMR)
Special considerations
Specific technical and cognitive skills for endoscopic resection techniques
Equipment for EMR. The proper endoscope
Equipment independent of the procedure. Adequate monitoring and supervision during sedation
CO2 insufflation
Endoscopic flush pump
Organ‐specific equipment
Patient preparation. Focus on informed consent
Patient condition and alternative treatment options
Patient preparation
Key steps for proper technique in EMR (see Video 19.1) Evaluation of the lesion
Marking
Submucosal injection
Resection techniques for EMR
Classic EMR (lift and cut technique; saline‐assisted snare resection)
CapEMR
“Band and snare” EMR
Endoscopic submucosal dissection
Lesions to be considered for ESD
Skills for ESD and who should do it. Prerequisite level of expertise and skill for learning ESD
Special considerations for ESD
Specific technical and cognitive skills for ESD
Equipment for ESD. General considerations on ESD equipment
Essential equipment for ESD
Equipment independent of the procedure. Adequate monitoring and supervision during sedation
Endoscopic flush pump
Positioning of the patient for ESD
Antibiotics and proton pump inhibitor (PPI)
Pre‐interventional endosonography (EUS)
Transparent distal endoscope cap for ESD
Injection substances for ESD
Resection knifes. Resection knifes
Resection knifes with integrated fluid injection capability. Water jet technology and “HybridKnife” (Figure 19.11)
FlushKnife
Electrosurgical settings
Procedural steps of endoscopic submucosal dissection (Figures 19.9; 19.12–19.15)
Submucosal injection
Circumferential incision
Submucosal dissection
Retrieval of the specimen
Inspection of the resection base and occlusion of vessels
Preparation of the specimen for histopathologic evaluation
Post‐EMR and post‐ESD management. Control endoscopy
Risk of secondary bleeding
Peri‐interventional antibiotics
Management of complications. Acute procedure‐related complications
Perforation
Late and secondary complications. Stricture formation
When to use EMR and when ESD?
Training and first steps in ESD
Endoscostrapic Full Thickness Resection using the Ovesco eFTRD® system. Characteristics of the eFTRD® system
Application
Clinical application of the system
Anatomical basics and clinical implications
e FTRD® in the colon
Material and accessories
Handling of the resection specimen
Special follow‐up care
The eFTR procedure with the gastroduodenal FTRD® system
Instruction for implementation
Further fields of FTRD® application
Conclusions and perspectives
Videos
References
20 Mucosal Ablation Techniques
Introduction
Procedures and equipment involved in mucosal ablation
Prerequisite cognitive and technical skills for trainees prior to learning mucosal ablation
Setting of training
Specific knowledge trainees must acquire during training to perform esophageal mucosal ablation. Patient selection
Selection of particular ablation method
Anticoagulation considerations
Warfarin
Heparin
Direct oral anticoagulants
Aspirin
Clopidogrel
Acid suppression
Post‐ablation analgesia
Pacemakers and implantable cardiac defibrillators (ICDs)
Post‐ablation surveillance
Equipment and technical steps. Argon plasma coagulation
Key steps
Radiofrequency ablation (RFA)
Equipment. Circumferential and focal ablation and energy generator
Key steps. Circumferential ablation (Figure 20.2, Video 20.1)
Focal ablation (Figure 20.3, Video 20.2)
Focal ablation with through‐the‐scope ablation catheter
Liquid nitrogen spray cryotherapy (LNSCT)
Equipment. Ablation with liquid nitrogen spray cryotherapy (truFreeze Spray Cryotherapy System):
Key steps. Ablation with liquid nitrogen spray cryotherapy (Figure 20.4, Video 20.3)
CryoBalloon Ablation System
Equipment. Nitrous oxide cryoballoon ablation system
Key steps
Opportunities and methods for training in mucosal ablation
Defining competency
Maintaining skill level
Videos
References
21 Complicated Polypectomy
Patient assessment and consent
Timing
Endoscopy Team
General principles
The electrosurgical unit
Carbon dioxide
Snares for polypectomy
The snare handle as an information center
Safety in snare handling
Techniques for successful removal of sessile polyps
Special techniques for sessile polyps
Pedunculated polyps
Fluid injection
The non‐lifting lesion
Retroflexion
EMRC
Lesions involving the ileocecal valve
Lesions at the appendiceal orifice
Lesions at the anorectal junction (Video 21.8)
Circumferential lesions
Endoscopic submucosal dissection (Videos 21.9 and 21.10)
Endoscopic full thickness resection
Adjuvant thermal ablation of the resection margin
Defect closure with mechanical clips
Deep mural injury
Surveillance
Two‐stage EMR
Adverse events associated with complex polypectomy
Training and achieving competency in endoscopic tissue resection
Summary
Videos
References
22 Training and Credentialing in Natural Orifice Transluminal Endoscopic Surgery (NOTES)
Training
Credentialing
Conclusion
References
23 Training in Bariatric Endoscopy
Bariatric endoscopy procedures
Training goals
Infrastructure and personnel. Facilities
Mentors
Simulators and hands‐on for training
Trainees
Settings
Pre‐procedural assessment
Equipment
Procedural considerations and techniques
Bariatric endoscopy procedures
Endoscopic management of post‐bariatric surgery complications
Leaks/fistulas
Stenosis
Foreign body reaction/pain syndromes
Band erosion/ring slippage
Ulceration
Revisional procedures for weight regain
Sclerotherapy
Argon plasma coagulation
Suturing (Apollo Endosurgery)
Incisionless Operating Platform and ROSE procedure
Primary bariatric and metabolic procedures
Gastric balloons
Endoluminal gastric volume reduction
OverStitch
Primary obesity surgery endoluminal (POSE)
Endoluminal metabolic devices
EndoBarrier
Duodenal mucosal resurfacing (DMR)
Others
Aspiration therapy
TransPyloric Shuttle
Botulinum toxin injection
Defining competency for particular skill
Conclusion
References
24 Repair of Mucosal Defects: A Primer on Endoscopic Closure of Gastrointestinal Perforations
Introduction
Learning to close perforations
Endoscopic closure devices
Key steps in endoscopic management of gastrointestinal perforations
Prevent perforation
Diagnosis of perforation
Immediate endoscopic management
Postendoscopic perforation closure management
Setting and tools for training
Conclusion
Videos
References
25 Esophageal, Gastroduodenal, and Colorectal Stenting
Procedure(s) to be considered
Prerequisite level of expertise and skill for learning this
Special considerations
Specific technical and cognitive skill sets
Equipment
Key steps of proper technique. Esophagus
Pre‐esophageal stenting evaluation
Esophageal stent placement
Antegrade technique
Combined antegrade and retrograde (CAR) technique
Post‐esophageal stenting management. Stent removal for benign indications
Management of complications. Procedure‐related complications
Long‐term complications
Distal stomach/duodenum
Pre‐gastroduodenal stenting evaluation
Gastroduodenal stent placement
Post‐gastroduodenal stenting evaluation. CBD obstruction
Management of complications. Procedure‐related complications
Long‐term complications
Colon/rectum
Pre‐colorectal stenting evaluation
Colorectal stent placement
Post‐colorectal stenting evaluation. Management of complications. Procedure‐related complications
Long‐term complications
Setting and tools for training
Defining competency
Maintaining skill level
Videos
References
26 ERCP Management of Complicated Stone Disease of the Bile Duct and Pancreas
Mechanical lithotripsy
Large‐diameter balloon sphincteroplasty
Cholangiopancreatoscopy
Electrohydraulic lithotripsy
Laser lithotripsy
Extracorporeal shock wave lithotripsy and pancreatic duct stones
Endoscopic ultrasound as an adjunct
Difficult anatomy
Training modalities
Competency
Videos
References
27 ERCP Management of Malignancy: Tissue Sampling, Metal Stent Placement, and Ampullectomy
Introduction
Tissue sampling at ERCP
Fluid aspiration
Brush cytology
Fine needle aspiration
Forceps biopsy and cytology
Triple sampling
Intraprocedural ERCP tissue diagnosis
Metal stent placement
Tissue‐proven cancer, not resectable
Tissue‐proven cancer, resectable or borderline resectable
No tissue diagnosis, resectable, or nonresectable
Extrahepatic SEMS placement
Bifurcation SEMS placement
Management of ampullary neoplasms
Thoughts on advanced endoscopy training
Videos
References
28 Sphincter of Oddi Manometry
Patient selection
Method of SOM. Sedation
Equipment
Technical performance of SOM (see accompanying Video 28.1)
Interpretation criteria
Reproducibility of SOM
Complications of SOM
Training in SOM
Video
References
29 Training for Pseudocyst Management
Procedure(s) to be considered
Prerequisite level of expertise and skill for learning this
Special considerations
Specific technical and cognitive skill sets
Acute peripancreatic fluid collections
Acute pancreatic pseudocyst
Chronic pancreatic pseudocyst
Acute necrotic collection (ANC)
Walled‐off Pancreatic Necrosis (WOPN)
Equipment. Essential equipment
0.018”–0.035” guidewires (depending on needle used)
Salvage accessories:
Key steps of proper technique
Pre‐drainage evaluation
Anesthesia support
Types of endoscopic drainage
Transmural drainage
EUS‐guided transmural drainage
Traditional Drainage Techniques
Newer drainage techniques
Transpapillary drainage
Setting and tools for training
Defining competency
Maintaining skill level
Videos
References
30 Enteral Access Techniques: Percutaneous Endoscopic Gastrostomy and Jejunostomy
Introduction
Prerequisite expertise and skill
Setting
Equipment
Key steps for proper technique. Percutaneous endoscopic gastrostomy (PEG) insertion, replacement and removal. Pull‐ or push‐type PEG insertion
Peel‐away sheath‐type PEG insertion [2,5]
PEG replacement and removal
A PEG replacement
B PEG removal
Percutaneous endoscopic gastrostomy with jejunal (or duodenal) extension (PEG‐J) and direct percutaneous endoscopic jejunostomy (DPEG) insertion, replacement, and removal
A PEG‐J insertion
I De novo PEG‐J insertion drag and pull technique
II Wire‐guided insertion technique
III Transabdominal endoscopic insertion technique
IV PEG‐J insertion technique through an existing PEG
B DPEJ insertion
Starting enteral nutrition
Setting and tools for training
Defining competency
Maintenance of skills
Videos
References
31 Training in GI Upper Motility Techniques
Esophageal manometry testing. Esophageal Anatomy
Lower esophageal sphincter
Esophageal motility studies
Procedure and patient protocols
Analysis of HRM. Baseline assessment (Landmark)
Analysis of swallows
Integrated relaxation pressure (IRP)
Contractile deceleration point (CDP)
Distal latency (DL)
Contraction vigor—distal contractile integral (DCI)
Compartmentalized esophagus
Panesophageal pressurization
Diagnosis of esophageal motor disorders using Chicago Classification
Conclusion
Endoflip™ testing
Reflux testing
pH testing
pH and impedance testing
Wireless motility capsule (WMC) testing
WMC procedure
WMC interpretation
Assessment of gastric emptying
Specific applications of WMC testing
Possible complications
References
32 Training in the Endoscopic Management of Anorectal Disorders
Introduction
Procedures and equipment in diagnosis and management
Prerequisite cognitive and technical skills for trainees prior to learning DRE anoscopy and hemorrhoid treatment. Visual examination
The digital rectal exam
Anoscopy
Specific knowledge trainees must acquire during training to perform office hemorrhoid banding
Selection of particular treatment method
Anticoagulation considerations
Post banding analgesia
Incision and drainage of acutely thrombosed external hemorrhoids
Anal fissures
Anal pruritus
Treatment
Anorectal manometry
Indications for ARM:
References
33 The Endoscopic Management of Immediate Complications of Therapeutic Endoscopy
Introduction
Assessing risk prior to procedure
Intraprocedure recognition of complications. Risks of therapeutic endoscopy
Risks of therapeutic colonoscopy
Risks of therapeutic ERCP/EUS
Avoiding complications
Training to manage complications
Post‐procedure follow‐up
Videos
References
34 Assessing Manpower Needs in Gastroenterology and Digestive Endoscopy: Lessons from the Past and Implications for the Future of Endoscopic Training
Modeling manpower
Physician workforce estimates
Gastroenterology workforce modeling
Future projections in gastroenterology: lessons from the past
Endoscopic demands for screening colonoscopy
Endoscopic training for the surgeon
Future demands for endoscopy
Demand for training in gastroenterology
Conclusions
Acknowledgments
References
35 International Opportunities for Obtaining Endoscopy Training
Introduction
Available opportunities
Benefits. Immersion
Perspective
Visibility
Culture
Drawbacks
Training in Japan
A successful training model
Creating a ‘flying’ training center
Overcoming the lack of resources
Portable simulators
Combining simulator training and patient’s observation
Conclusion
References
36 Virtual Tools for Training: The Spectrum of Apps and Virtual Aids for Learning Gastrointestinal Endoscopy
Introduction
GI procedure videos
Online resources with GI procedural videos
GI society educational platforms
Smartphone/Smartpad applications
On‐demand videos from conferences and virtual courses
Podcasts
Virtual learning and the future
Video
37 Providing Resources and Opportunities for Retraining for Practicing Endoscopists
References
38 Evolving Role of GI Societies and Industry in Training Endoscopists to Perform New Techniques: Supporting the Process and Setting the Standards
Background. Historical perspective
Making it all possible: novel simulator platforms in endoscopic training
Evolving role of industry
Evolving role of GI societies
IT&T Center initiative
Expanding course offerings and brand extension
Future directions and challenges. GI society role in navigation and standardization of new technology evaluation and adoption
Video
References
39 The Importance of Skills Assessment and Recording Personal Outcomes in the Future of Training
The initial training period
Tools for direct observation and assessment of endoscopy skills
Credentialing
Competence in practice
Impact of practice measurements on the training process and future directions
Conclusion
References
Index
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