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2. 73 A PROSPECTIVE MULTICENTER STUDY EVALUATING EUS AND ERCP COMPETENCE DURING ADVANCED ENDOSCOPY TRAINING AND SUBSEQUENT INDEPENDENT PRACTICE: THE RAPID ASSESSMENT OF TRAINEE ENDOSCOPY SKILLS (RATES2) STUDY

Author

Sachin B. Wani, Rajesh N. Keswani, Matt Hall, Samuel Han, Eva Aagaard, Violette C. Simon, Linda Carlin, Swan Ellert, Wasif M. Abidi, Todd H. Baron, Brian C. Brauer, Hemant Chatrath, Gregory A. Cote, Koushik K. Das, Christopher J. DiMaio, Steven A. Edmundowicz, Ihab I. El Hajj, Hazem T. Hammad, Sujai Jalaj, Michael L. Kochman, Sri Komanduri, Linda S. Lee, Daniel Mullady, V. Raman Muthusamy, Andrew S. Nett, Mojtaba S. Olyaee, Kavous Pakseresht, Pranith Perera, Patrick Pfau, Cyrus Piraka, Amit Rastogi, Raj J. Shah, Rishi Sharma, James M. Scheiman, James H. Tabibian, Dushant Uppal, Shiro Urayama, Andrew Y. Wang, Tobias Zuchelli, Erik Bowman, Gabriel Lang, David E. Loren, Abdul Hamid El Chafic, Patrick Yachimski, Anthony Gamboa, John M. Poneros, Wahid Wassef, Muhammad Sohail, Tyler Stevens, Bradley Confer, Nalini M. Guda, S. Ian Gan, Anthony Razzak, Stuart R. Gordon, Jason Ferriera, Subhas Banerjee, Abhishek Choudhary, Andrew M. Dries, Jonathan M. Buscaglia, Demetrios Tzimas, Sergio Zepeda-Gomez, Sana Kenshil, Frank Lukens, Michael Bartel, Paul Jowell, Joshua P. Spaete, Brian Riff, Cynthia Harris, Shreyas Saligram, Bhargava Gannavarapu, Amitabh Chak, Ajaypal Singh, and Dayna Early

Subjects
medicine.medical_specialty, medicine.diagnostic_test, Multicenter study, business.industry, Gastroenterology, Medicine, Radiology, Nuclear Medicine and imaging, Medical physics, Independent practice, business, Competence (human resources), Endoscopy, Rapid assessment
Published
2018
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4. Setting minimum standards for training in EUS and ERCP: results from a prospective multicenter study evaluating learning curves and competence among advanced endoscopy trainees

Author

Andrew Nett, Violette C. Simon, Brian C. Brauer, Sujai Jalaj, Anthony Gamboa, Cynthia L. Harris, Ajaypal Singh, Hazem T. Hammad, James H. Tabibian, Gabriel Lang, Nalini M. Guda, Jayaprakash Sreenarasimhaiah, Pranith Perera, Linda Carlin, Stuart R. Gordon, Koushik K. Das, Amitabh Chak, Dayna S. Early, Raj J. Shah, Abhishek Choudhary, Abdul Hamid El Chafic, David E. Loren, Frank Lukens, Gregory A. Cote, John M. Poneros, Tobias Zuchelli, Cyrus Piraka, Samuel Han, Christopher J. DiMaio, Dushant S. Uppal, Patrick Yachimski, Sana Kenshil, Sergio Zepeda-Gómez, Paul S. Jowell, Jason B. Klapman, Patrick R. Pfau, Tyler Stevens, Andrew Y. Wang, Matthew Hall, Raman Muthusamy, Hemant Chatrath, Sri Komanduri, Wahid Wassef, Swan Ellert, Andrew Dries, Subhas Banerjee, Linda S. Lee, Shreyas Saligram, Daniel Mullady, Sachin Wani, James M. Scheiman, Ihab I. El Hajj, Domenico Vitterbo, Amit Rastogi, Brian P. Riff, Todd H. Baron, Muhammad Sohail, Eva Aagaard, Mojtaba Olyaee, Jonathan M. Buscaglia, Jason Ferreira, Rajesh N. Keswani, Michael J. Bartel, Rishi Sharma, Shiro Urayama, Demetrios Tzimas, Isaiah P. Schuster, Ian S. Gan, Erik Bowman, Michael L. Kochman, Kavous Pakseresht, Bradley Confer, Steven A. Edmundowicz, Wasif M. Abidi, Bhargava Gannavarapu, Joshua P. Spaete, Lisa M. Gangarosa, and Anthony Razzak

Subjects
Endoscopic ultrasound, medicine.medical_specialty, CUSUM, Article, Endosonography, 03 medical and health sciences, Sphincterotomy, Endoscopic, 0302 clinical medicine, medicine, Humans, Radiology, Nuclear Medicine and imaging, Medical physics, Endoscopy, Digestive System, Prospective Studies, Fellowships and Scholarships, Grading (education), Competence (human resources), Endoscopic Ultrasound-Guided Fine Needle Aspiration, Cholangiopancreatography, Endoscopic Retrograde, Endoscopic retrograde cholangiopancreatography, medicine.diagnostic_test, business.industry, Gastroenterology, Endoscopy, Clinical trial, Learning curve, Education, Medical, Graduate, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, Clinical Competence, business, Learning Curve
Abstract

Background and Aims Minimum EUS and ERCP volumes that should be offered per trainee in “high quality” advanced endoscopy training programs (AETPs) are not established. We aimed to define the number of procedures required by an “average” advanced endoscopy trainee (AET) to achieve competence in technical and cognitive EUS and ERCP tasks to help structure AETPs. Methods American Society for Gastrointestinal Endoscopy (ASGE)-recognized AETPs were invited to participate; AETs were graded on every fifth EUS and ERCP examination using a validated tool. Grading for each skill was done using a 4-point scoring system, and learning curves using cumulative sum analysis for overall, technical, and cognitive components of EUS and ERCP were shared with AETs and trainers quarterly. Generalized linear mixed-effects models with a random intercept for each AET were used to generate aggregate learning curves, allowing us to use data from all AETs to estimate the average learning experience for trainees. Results Among 62 invited AETPs, 37 AETs from 32 AETPs participated. Most AETs reported hands-on EUS (52%, median 20 cases) and ERCP (68%, median 50 cases) experience before starting an AETP. The median number of EUS and ERCPs performed per AET was 400 (range, 200-750) and 361 (range, 250-650), respectively. Overall, 2616 examinations were graded (EUS, 1277; ERCP-biliary, 1143; pancreatic, 196). Most graded EUS examinations were performed for pancreatobiliary indications (69.9%) and ERCP examinations for ASGE biliary grade of difficulty 1 (72.1%). The average AET achieved competence in core EUS and ERCP skills at approximately 225 and 250 cases, respectively. However, overall technical competence was achieved for grade 2 ERCP at about 300 cases. Conclusion The thresholds provided for an average AET to achieve competence in EUS and ERCP may be used by the ASGE and AETPs in establishing the minimal standards for case volume exposure for AETs during their training. (Clinical trial registration number: NCT02509416.)

Published
2019

5. 929 MOST ADVANCED ENDOSCOPY TRAINEES (AETS) MEET QUALITY INDICATOR (QI) THRESHOLDS IN THE FIRST YEAR OF INDEPENDENT PRACTICE: THE RAPID ASSESSMENT OF TRAINEE ENDOSCOPY SKILLS (RATES2) STUDY

Author

Hemant Chatrath, Violette C. Simon, Shreyas Saligram, Dayna S. Early, James H. Tabibian, Muhammad Sohail, Dushant S. Uppal, Samuel Han, Abhishek Choudhary, Christopher J. DiMaio, Sachin Wani, Andrew Y. Wang, Abdul Hamid El Chafic, Kavous Pakseresht, Hazem T. Hammad, Matthew Hall, Tobias Zuchelli, Gregory A. Cote, Gabriel Lang, Linda Carlin, Koushik K. Das, Rajesh N. Keswani, Steven A. Edmundowicz, Ajaypal Singh, Amit Rastogi, Rishi Sharma, Brian P. Riff, Eva Aagaard, Swan Ellert, Sujai Jalaj, Michael J. Bartel, Isaiah P. Schuster, Erik Bowman, Bhargava Gannavarapu, Daniel Mullady, Jason Ferriera, V. Raman Muthusamy, Demetrios Tzimas, Bradley Confer, Sri Komanduri, and Raj J. Shah

Subjects
medicine.medical_specialty, medicine.diagnostic_test, business.industry, media_common.quotation_subject, Gastroenterology, Rapid assessment, Endoscopy, medicine, Radiology, Nuclear Medicine and imaging, Medical physics, Quality (business), Independent practice, business, media_common
Published
2018
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7. Competence in Endoscopic Ultrasound and Endoscopic Retrograde Cholangiopancreatography, From Training Through Independent Practice

Author

Tobias Zuchelli, David E. Loren, Samuel Han, Sujai Jalaj, Frank Lukens, Christopher J. DiMaio, Raj J. Shah, Bhargava Gannavarapu, Joshua P. Spaete, Ihab I. El Hajj, Lisa M. Gangarosa, Andrew Dries, Michael J. Bartel, Muhammad Sohail, Rajesh N. Keswani, Stuart R. Gordon, Brian C. Brauer, Pranith Perera, Hemant Chatrath, Wahid Wassef, Isaiah P. Schuster, Srinadh Komanduri, Anthony Gamboa, Subhas Banerjee, Todd H. Baron, Dushant S. Uppal, Erik Bowman, Andrew Nett, Demetrios Tzimas, Jason B. Klapman, Michael L. Kochman, Brian P. Riff, Cyrus Piraka, Gregory A. Cote, Ajaypal Singh, Tyler Stevens, Eva Aagaard, Daniel Mullady, Bradley Confer, Sachin Wani, Shreyas Saligram, Jayaprakash Sreenarasimhaiah, Hazem T. Hammad, Dayna S. Early, Shiro Urayama, Mojtaba Olyaee, John M. Poneros, Patrick Yachimski, Sana Kenshil, Abhishek Choudhary, Andrew Y. Wang, Amitabh Chak, Jason Ferreira, V. Raman Muthusamy, Linda S. Lee, Gabriel Lang, Rishi Sharma, Linda Carlin, Violette C. Simon, Amit Rastogi, Steven A. Edmundowicz, Anthony Razzak, James H. Tabibian, Kavous Pakseresht, Abdul Hamid El Chafic, Sergio Zepeda-Gómez, Paul S. Jowell, Nalini M. Guda, Koushik K. Das, Swan Ellert, James M. Scheiman, Domenico Vitterbo, Cynthia L. Harris, Wasif M. Abidi, Jonathan M. Buscaglia, Patrick R. Pfau, Matthew Hall, and Ian S. Gan

Subjects
Endoscopic ultrasound, medicine.medical_specialty, education, Endosonography, 03 medical and health sciences, 0302 clinical medicine, Interquartile range, medicine, Humans, Prospective Studies, Independent practice, Prospective cohort study, Competence (human resources), Quality Indicators, Health Care, Cholangiopancreatography, Endoscopic Retrograde, Endoscopic retrograde cholangiopancreatography, Hepatology, medicine.diagnostic_test, business.industry, General surgery, Gastroenterology, digestive system diseases, Endoscopy, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, Clinical Competence, business, Learning Curve, Cohort study
Abstract

Background & Aims It is unclear whether participation in competency-based fellowship programs for endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) results in high-quality care in independent practice. We measured quality indicator (QI) adherence during the first year of independent practice among physicians who completed endoscopic training with a systematic assessment of competence. Methods We performed a prospective multicenter cohort study of invited participants from 62 training programs. In phase 1, 24 advanced endoscopy trainees (AETs), from 20 programs, were assessed using a validated competence assessment tool. We used a comprehensive data collection and reporting system to create learning curves using cumulative sum analysis that were shared with AETs and trainers quarterly. In phase 2, participating AETs entered data into a database pertaining to every EUS and ERCP examination during their first year of independent practice, anchored by key QIs. Results By the end of training, most AETs had achieved overall technical competence (EUS 91.7%, ERCP 73.9%) and cognitive competence (EUS 91.7%, ERCP 94.1%). In phase 2 of the study, 22 AETs (91.6%) participated and completed a median of 136 EUS examinations per AET and 116 ERCP examinations per AET. Most AETs met the performance thresholds for QIs in EUS (including 94.4% diagnostic rate of adequate samples and 83.8% diagnostic yield of malignancy in pancreatic masses) and ERCP (94.9% overall cannulation rate). Conclusions In this prospective multicenter study, we found that although competence cannot be confirmed for all AETs at the end of training, most meet QI thresholds for EUS and ERCP at the end of their first year of independent practice. This finding affirms the effectiveness of training programs. Clinicaltrials.gov ID NCT02509416 .

Published
2018
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8. 762 SETTING MINIMUM STANDARDS FOR TRAINING IN EUS AND ERCP: RESULTS FROM A PROSPECTIVE MULTICENTER STUDY EVALUATING LEARNING CURVES AND COMPETENCE AMONG ADVANCED ENDOSCOPY TRAINEES (AETS)

Author

Sachin B. Wani, Samuel Han, Violette C. Simon, Matt Hall, Dayna Early, Eva Aagaard, Linda Carlin, Swan Ellert, Wasif M. Abidi, Todd H. Baron, Brian C. Brauer, Hemant Chatrath, Gregory A. Cote, Koushik K. Das, Christopher J. DiMaio, Steven A. Edmundowicz, Ihab I. El Hajj, Hazem T. Hammad, Sujai Jalaj, Michael L. Kochman, Sri Komanduri, Linda S. Lee, Daniel Mullady, V. Raman Muthusamy, Andrew S. Nett, Mojtaba S. Olyaee, Kavous Pakseresht, Pranith Perera, Patrick Pfau, Cyrus Piraka, Amit Rastogi, Raj J. Shah, Rishi Sharma, James M. Scheiman, James H. Tabibian, Dushant Uppal, Shiro Urayama, Andrew Y. Wang, Tobias Zuchelli, Erik Bowman, Gabriel Lang, David E. Loren, Abdul Hamid El Chafic, Patrick Yachimski, Anthony Gamboa, John M. Poneros, Wahid Wassef, Muhammad Sohail, Tyler Stevens, Bradley Confer, Nalini M. Guda, S. Ian Gan, Anthony Razzak, Stuart R. Gordon, Jason Ferriera, Subhas Banerjee, Abhishek Choudhary, Andrew M. Dries, Jonathan M. Buscaglia, Demetrios Tzimas, Sergio Zepeda-Gomez, Sana Kenshil, Frank Lukens, Michael Bartel, Paul Jowell, Joshua P. Spaete, Brian Riff, Cynthia Harris, Shreyas Saligram, Bhargava Gannavarapu, Amitabh Chak, Ajaypal Singh, and Rajesh N. Keswani

Subjects
Gastroenterology, Radiology, Nuclear Medicine and imaging
Published
2018
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9. CD4+ T cells from Copolymer-1 immunized mice protect dopaminergic neurons in the 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine model of Parkinson's disease

Author

Howard E. Gendelman, Ashley D. Reynolds, Chad Laurie, R. Lee Mosley, Erik Bowman, and Ozlem Coskun

Subjects
CD4-Positive T-Lymphocytes, Male, Adoptive cell transfer, Tyrosine 3-Monooxygenase, Dopamine, Mitomycin, T cell, Immunology, Enzyme-Linked Immunosorbent Assay, Substantia nigra, Pharmacology, Neuroprotection, Mice, chemistry.chemical_compound, Antineoplastic Combined Chemotherapy Protocols, medicine, Glial cell line-derived neurotrophic factor, Animals, Immunology and Allergy, Ifosfamide, Parkinson Disease, Secondary, Neurons, Dose-Response Relationship, Drug, biology, MPTP, Neurodegeneration, Glatiramer Acetate, Flow Cytometry, medicine.disease, Adoptive Transfer, Corpus Striatum, Substantia Nigra, Disease Models, Animal, medicine.anatomical_structure, Neurology, chemistry, 1-Methyl-4-phenyl-1,2,3,6-tetrahydropyridine, biology.protein, Neurology (clinical), Cisplatin, Peptides, medicine.drug
Abstract

Adoptive transfer of lymphoid cells from Copolymer 1 (Cop-1) immunized mice leads to T cell accumulation within the substantia nigra, modulation of microglial responses, upregulation of glial cell derived neurotrophic factor, and protection of the nigrostriatum following 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) intoxication. We now demonstrate that T cells isolated from lymph nodes and spleens of Cop-1 immunized animals protect the nigrostriatal system from MPTP-induced neurodegeneration in a dose-dependent manner. CD4+ T cells elicited the most significant neuroprotective response while high titers of anti-Cop-1 antibodies showed no effect. These data further support the use of immunomodulatory strategies for Parkinson's disease.

Published
2007
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10. Use of i-scan Endoscopic Image Enhancement Technology in Clinical Practice to Assist in Diagnostic and Therapeutic Endoscopy: A Case Series and Review of the Literature

Author

Rashmi Agni, Mark E. Benson, Patrick R. Pfau, Deepak V. Gopal, Shawn M. Hancock, Mark Reichelderfer, Jyothiprashanth Prabakaran, Jennifer M. Weiss, and Erik Bowman

Subjects
medicine.medical_specialty, lcsh:Medical technology, Article Subject, Radiation proctitis, business.industry, medicine.medical_treatment, Intestinal metaplasia, medicine.disease, digestive system diseases, Surgery, Duodenal Adenoma, medicine.anatomical_structure, lcsh:R855-855.5, Dysplasia, Therapeutic endoscopy, medicine, Rectal Adenocarcinoma, Clinical Study, Radiology, Nuclear Medicine and imaging, Radiology, Esophagus, business, Esophagitis
Abstract

Background. i-scan is a software-driven technology that allows modifications of sharpness, hue, and contrast to enhance mucosal imaging. It uses postimage acquisition software with real-time mapping technology embedded in the endoscopic processor. Aims. To review applications of i-scan technology in clinical endoscopic practice. Methods. This is a case series of 20 consecutive patients who underwent endoscopic procedures where i-scan image enhancement algorithms were applied. The main outcome measures were to compare mucosal lesions with high-definition white light endoscopy (HD-WLE) and i-scan image enhancement for the application of diagnostic sampling and therapy. Results. 13 cases involving the upper GI tract and 7 cases of the lower GI tract are included. For upper GI tract pathology i-scan assisted in diagnosis or therapy of Barrett’s esophagus with dysplasia, esophageal adenocarcinoma, HSV esophagitis, gastric MALT lymphoma, gastric antral intestinal metaplasia with dysplasia, duodenal follicular lymphoma, and a flat duodenal adenoma. For lower GI tract pathology i-scan assisted in diagnosis or therapy of right-sided serrated adenomas, flat tubular adenoma, rectal adenocarcinoma, anal squamous cell cancer, solitary rectal ulcer, and radiation proctitis. Conclusions. i-scan imaging provides detailed topography of mucosal surfaces and delineates lesion edges, which can directly impact endoscopic management.

Published
2012

13. Tu1662 Use of I-SCAN™ Endoscopic Image Enhancement Techonology in Clinical Practice to Assist in Diagnostic and Therapeutic Endoscopy

Author

Erik Bowman, Jyothiprashanth Prabakaran, Mark E. Benson, Shawn M. Hancock, Mark Reichelderfer, Rashmi Agni, Deepak V. Gopal, Jennifer M. Weiss, and Patrick R. Pfau

Subjects
Clinical Practice, medicine.medical_specialty, business.industry, Therapeutic endoscopy, medicine.medical_treatment, Gastroenterology, medicine, Radiology, Nuclear Medicine and imaging, Radiology, business, Endoscopic image
Published
2012
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14. Su1535 High Definition Colonoscopy Combined With I-Scan Imaging Technology Is Superior in the Detection of Adenomas and Advanced Lesions Compared to High Definition Colonoscopy Alone

Author

Erik Bowman, Deepak V. Gopal, Veronika Gagovic, Mark Reichelderfer, Mark E. Benson, Benjamin S. Hall, and Patrick R. Pfau

Subjects
medicine.medical_specialty, medicine.diagnostic_test, business.industry, Gastroenterology, medicine, Imaging technology, Colonoscopy, High definition, Radiology, Nuclear Medicine and imaging, Radiology, business
Published
2011
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