SNFGE SNFGE
 
Thématique :
- Endoscopie/Imagerie
- Œsophage/Estomac
Originalité :
Très original
Solidité :
Très solide
Doit faire évoluer notre pratique :
Immédiatement
 
 
Nom du veilleur :
Professeur Emmanuel CORON
Coup de coeur :
 
 
Endoscopy
  2015/11  
 
  2015 Nov;47(11):972-9  
  doi: 10.1055/s-0034-1392558  
 
  Learning endoscopic resection in the esophagus  
 
  van Vilsteren FG, Pouw RE, Alvarez Herrero L, Bisschops R, Houben M, Peters FT, Schenk BE, Weusten BL, Schoon EJ, Bergman JJ  
  http://www.ncbi.nlm.nih.gov/pubmed/26361090  
 
 

BACKGROUND
Endoscopic resection is the cornerstone of endoscopic management of esophageal early neoplasia. However, endoscopic resection is a complex technique requiring knowledge and expertise. Our aims were to identify the most important learning points in performing endoscopic resection in a training setting and to provide information on how to improve endoscopic resection technique.

METHODS
Six gastroenterologists at centers with multidisciplinary expertise in upper gastrointestinal oncology participated in a structured endoscopic resection training program, consisting of four training days with lectures and hands-on training on live pigs, further one-to-one hands-on training days, and written feedback (by an expert) on videos of unsupervised endoscopic resection procedures. The first 20 endoscopic resections of each participant were prospectively registered. Ninety learning points were independently identified by participants using a standardized questionnaire and by an expert providing written feedback on 33 unsupervised endoscopic resection videos. Three expert endoscopists selected and ranked the most important learning points in a consensus meeting. Results. The top 10 tips (illustrated by unique videos of three perforations) were: (1) allow time for inspection and use a high-definition endoscope; (2) create a preprocedural plan by placing electrocoagulation markings; (3) know the management of bleeding; (4) optimize the endoscopic view by repeatedly cleaning out stomach and target area; (5) use a therapeutic endoscope during resection; (6) always perform a test suction; (7) keep instruments close to the tip; (8) lift edges in piecemeal endoscopic cap resections; (9) know the management of perforation; (10) pin specimens down.

CONCLUSIONS
This study summarized the most important learning points for performing endoscopic resection encountered during a structured endoscopic resection training program.

 
Question posée
 
Comment apprendre la mucosectomie oesophagienne ? Et quelles en sont les étapes clefs ?
 
Question posée
 
Cette étude détaille la mise au point et les caractéristiques d’un programme de formation néerlandais étalé sur plusieurs mois et très complet. Au final, l’enseignement repose sur 90 points-clés qui sont appris grâce à une combinaison de cours théoriques, enseignement pratique sur porc vivant anesthésié, compagnonnage individuel avec un expert et retour écrit d’expert à partir des bandes vidéos concernant les premières mucosectomies réalisées de manière autonome par l’étudiant.
 
Commentaires

Cette étude rapporte l’exemple-type d’une organisation pédagogique très structurée qui va très au-delà du compagnonnage ‘traditionnel’ et permet indéniablement de diffuser une technique interventionnelle dans des conditions optimales de sécurité et d’efficacité.

 
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