Background and Study Aims: Endoscopy workshops are thought to be associated with larger numbers of complications than routine clinical treatment. In this study, patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) during live demonstrations were compared with matched patients treated in an ERCP unit.
Patients and Methods: Patients who underwent ERCP during workshops over a 12-year period were reviewed. The control for each patient was the next patient admitted to the same ERCP unit with similar indications. Possible delays before treatment, ERCP indications, the use of general anesthesia, standard endoscopic and special treatments, success and complication rates for ERCP, prolonged hospitalization periods, and financial benefits for patients were assessed.
Results: A total of 168 workshop patients and 168 control patients were compared. ERCP was delayed in 18 patients to allow treatment during the workshops. General anesthesia was used in 87.5 % of the workshop patients, in comparison with 44 % of the control patients (P < 0.001). The duration of the endoscopies and radiation exposure did not differ, and the endoscopic treatments carried out also did not differ significantly, with the exception of cholangiopancreatoscopy (7 % in the workshop group versus 0 %; P < 0.01). The success and complication rates were similar in the workshop and control patients, as was the duration of hospitalization. Among the patients treated during workshops, 45 % benefited financially, as they were not charged for stents or other devices.
Conclusions: These results suggest that, in this setting, ERCP performed during live demonstrations is safe and raises no major ethical problems.
References
-
1
Cotton P B.
Live endoscopy demonstrations are great, but….
Gastrointest Endosc.
2000;
51
627-629
-
2
Waye J D.
Continuing education in endoscopy: live courses or video format?.
Gastrointest Endosc.
2000;
52
447-451
-
3
Axon A.
Ethical considerations in gastroenterology and endoscopy.
Dig Dis.
2002;
20
220-225
-
4
Ananthakrishnan N.
The ethics of live operative workshops.
Natl Med J India.
2003;
16
340
-
5
Ramesh H.
Live operative workshops: ethical issues.
Natl Med J India.
2004;
17
224
-
6
Nagral S.
Live operative workshops: a critique.
Natl Med J India.
2004;
17
00-2
-
7
Ardhanari R.
In defence of live operative workshops.
Natl Med J India.
2004;
17
99-100
-
8
White B D.
Current ethical and legal issues in gastrointestinal endoscopy.
Gastrointest Endosc Clin N Am.
1995;
5
421-432
-
9
Guidelines for establishment of gastrointestinal endoscopy areas .
.
Gastrointest Endosc.
1991;
37
661-662
-
10
Mulder C J, Tan A C, Huibregtse K.
Guidelines for designing an endoscopy unit: report of the Dutch Society of Gastroenterologists.
Endoscopy.
1997;
29
i-vi
-
11
Rabenstein T, Hahn E G.
Post-ERCP pancreatitis: is the endoscopist’s experience the major risk factor?.
J Pancreas.
2002;
3
177-187
-
12
Freeman M L.
Adverse outcomes of ERCP.
Gastrointest Endosc.
2002;
56 (6 Suppl)
S273-282
-
13
Cotton P B.
Outcomes of endoscopy procedures: struggling towards definitions.
Gastrointest Endosc.
1994;
40
514-518
-
14
Devière J, Ponchon T, Beilenhoff U. et al .
Recommendations of the ESGE workshop on ethical-legal issues concerning live demonstrations in digestive endoscopy.
Endoscopy.
2003;
35
765-767
-
15
Kruse A, Beilenhoff U, Axon A T. et al .
ESGE/ESGENA guideline for live demonstration courses.
Endoscopy.
2003;
35
781-784
-
16 Mazaris G J, Ladas S. Ethical and legal issues on live demonstrations in digestive endoscopy. In: Stanciu C, Ladas S, (eds.) Medical ethics: focus on gastroenterology and digestive endoscopy. Athens; Beta Medical Publishers 2002: 117-125
J. Devière, M. D.
Dept. of Gastroenterology, Erasmus Hospital
Route de Lennik, 808 · 1070 Brussels · Belgium
Fax: +32-2-555-4697
Email: jdeviere@ulb.ac.be
