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Learning curve of double‐guidewire technique by trainees during hands‐on endoscopic retrograde cholangiopancreatography training
Author(s) -
Wang Xiangping,
Ren Gui,
Xi Yibin,
Luo Hui,
Liang Shuhui,
Wang Biaoluo,
Tao Qin,
Luo Bing,
Qin Qian,
Farrell James J,
Guo Xuegang,
Wu Kaichun,
Pan Yanglin
Publication year - 2020
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.15120
Subject(s) - medicine , endoscopic retrograde cholangiopancreatography , pancreatitis , bile duct , learning curve , common bile duct , surgery , management , economics
Background and Aims Double‐guidewire technique (DWT) has been successfully performed by experts in difficult biliary cannulation as an advanced technique. This study aimed to define the learning curve and safety of DWT by trainees during hands‐on endoscopic retrograde cholangiopancreatography (ERCP) training. Methods Patients were eligible for inclusion in the study if the biliary cannulation was difficult and the pancreatic duct was inadvertently cannulated. DWT was performed by two trainees randomly under trainers' guidance. The primary outcome was the success rate of DWT biliary cannulation of trainees. Cumulative sum analysis was used to generate visual learning curves. Results A total of 60 patients with difficult cannulation were enrolled. The main indications for ERCP were common bile duct stones (65%) and biliary stricture (31.7%). The learning curve analysis showed that to achieve a 70% rate of successful DWT, 12 procedures were needed for trainee A and 15 for trainee B. Higher targeted success rate of DWT could be achieved if the number of DWT procedures increased. Compared with the early stage of learning DWT (case 1 to 15 for each trainee), trainees had significantly higher DWT success rate in the late stage (36.7% [11/30] vs 80% [24/30], P = 0.001). The final success rate of cannulation was 98.3% (59/60). The overall rate of post‐ERCP pancreatitis and adverse events was 6.7% (4/60) and 8.3% (5/60), respectively. Conclusions Double‐guidewire technique was safely performed by two novel trainees during hands‐on ERCP training. Fifteen procedures may be enough for trainees to achieve the competency of performing DWT. ( Clinicaltrials.gov number: NCT03707613).