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Endoscopy 2003; 35(11): 920-932
DOI: 10.1055/s-2003-43484
DDW Report 2003
© Georg Thieme Verlag Stuttgart · New York

Endoscopic Ultrasonography

M.  J.  Bruno1
  • 1Division of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Publication History

Publication Date:
07 November 2003 (online)

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Utility, Training and Clinical Impact

A survey on physician attitudes regarding endoscopic ultrasonography (EUS) and its availability was sent to gastroenterologists and surgeons involved in the care of patients with gastrointestinal tract cancers in three separate urban regions of the USA [1]. Preliminary results from 10 % of a total of 2211 surveys were reported. Only 5 % of respondents performed EUS themselves. Thirty-eight percent currently had no readily available access to diagnostic or interventional EUS. Thirty-two percent had never utilized EUS in the staging of esophageal, rectal, or pancreatic cancers. Inadequate training opportunities (52 %) and the high equipment costs (39 %) were cited as the greatest barriers to learning and performing EUS.

One abstract dealt with variations in EUS practice patterns among American and international endosonographers [2]. A survey questionnaire was distributed to attendees at the 13th International Symposium on EUS in New York, 2002. The majority of endosonographers appeared to be young physicians in academic practice. There was tremendous variation in levels of training, experience, and utilization among the endosonographers. Nineteen percent had more than 6 months of dedicated hands-on EUS training, 34 % had less than 6 months’ training, 26 % had learned EUS by observing others, and 18 % were self-taught.

Clearly, there is an urgent need for adequate EUS training facilities both in quantitative and in qualitative terms. A new easy-to-use interactive EUS simulator (CorVET) had been developed that can run on any PC-based system [3]. The scope and transducer orientation are controlled by the mouse. Besides the EUS window, a separate active window shows a three-dimensional model of the gastrointestinal tract with surrounding structures, the real-time position of the transducer, and the direction of the ultrasound beam. Both radial and linear-array imaging are available, and the simulation includes labeling of anatomical structures and correlations of EUS images with digital anatomy.

An EUS phantom was evaluated that allows trainees to acquire early skills in imaging, manipulation of Doppler and color Doppler systems, and basic techniques of EUS fine-needle aspiration (FNA) [4]. The phantom consists of a customized rubber form into which a swine esophagus and stomach are placed, surrounded by agar in which grapes are embedded to simulate lymph nodes. A rubber tube connected to a pump is placed along the esophagus to simulate the aorta.

An important issue in teaching EUS is how many supervised procedures are required for a trainee to become proficient in a certain technique. One abstract dealt with how much training is needed to perform EUS-FNA safely and accurately [5]. Fellows who were new to this technique were trained by an expert endosonographer. Accuracy in EUS-FNA required a minimum of 25 supervised procedures to reach a 90 % concordance in comparison with an expert endosonographer.

EUS is a technique that may have a profound impact on patient management. This was demonstrated in a series of patients with known or suspected malignancies [6]. Physicians requesting EUS for patients with known or suspected tumors were asked how they would manage their patient if EUS were not available. This was compared with the actual management post-EUS as determined by the same requesting physician. EUS led to a less invasive or simplified strategy in 37 %, and a more complicated or more invasive management strategy in 14 %.

References

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M. J. Bruno, M. D.

Division of Gastroenterology and Hepatology, Room C2-321, Academic Medical Center

Meibergdreef 9 · 1105 AZ Amsterdam · The Netherlands ·

Fax: + 31-20-5669156

Email: m.j.bruno@amc.uva.nl