Structured training program on confocal laser endomicroscopy for pancreatic cystic lesions: a multicenter prospective study among early-career endosonographers (with video).

Jorge D Machicado, Bertrand Napoleon, Venkata Akshintala, Ahmad Najdat Bazarbashi, Mohammad Bilal, Juan E Corral, Mohannad Dugum, Samuel Han, Farah S Hussain, Alyson M Johnson, Manol Jovani, Jennifer M Kolb, Paul Leonor, Peter J Lee, Ramzi Mulki, Hamza Shah, Harkirat Singh, Sergio A Sánchez-Luna, Shawn L Shah, Anand Singla, Eric J Vargas, Thomas Tielleman, Melica Nikahd, Megan Fry, Stacey Culp, Somashekar G Krishna

Journal: Gastrointestinal endoscopy 2023;98(6):953-964

PMID: 37473969

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Abstract

BACKGROUND AND AIMS

Data on how to teach endosonographers needle-based confocal laser endomicroscopy (nCLE)-guided histologic diagnosis of pancreatic cystic lesions (PCLs) are limited. Hence, we developed and tested a structured educational program to train early-career endosonographers in nCLE-guided diagnosis of PCLs.

METHODS

Twenty-one early-career nCLE-naïve endosonographers watched a teaching module outlining nCLE criteria for diagnosing PCLs. Participants then reviewed 80 high-yield nCLE videos, recorded diagnoses, and received expert feedback (phase 1). Observers were then randomized to a refresher feedback session or self-learning at 4 weeks. Eight weeks after training, participants independently assessed the same 80 nCLE videos without feedback and provided histologic predictions (phase 2). Diagnostic performance of nCLE to differentiate mucinous versus nonmucinous PCLs and to diagnose specific subtypes were analyzed using histopathology as the criterion standard. Learning curves were determined using cumulative sum analysis.

RESULTS

Accuracy and diagnostic confidence for differentiating mucinous versus nonmucinous PCLs improved as endosonographers progressed through nCLE videos in phase 1 (P < .001). Similar trends were observed with the diagnosis of PCL subtypes. Most participants achieved competency interpreting nCLE, requiring a median of 38 assessments (range, 9-67). During phase 2, participants independently differentiated PCLs with high accuracy (89%), high confidence (83%), and substantial interobserver agreement (κ = .63). Accuracy for nCLE-guided PCL subtype diagnoses ranged from 82% to 96%. The learned nCLE skills did not deteriorate at 8 weeks and were not impacted by a refresher session.

CONCLUSIONS

We developed a practical, effective, and durable educational intervention to train early-career endosonographers in nCLE-guided diagnosis of PCLs.

Address: Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA.; Gastroenterology Department, Hopital Privé Jean Mermoz, Ramsay Generale de Sante, Lyon, France.; Division of Gastroenterology and Hepatology, Johns Hopkins Medicine, Baltimore, Maryland, USA.; Division of Gastroenterology, Washington University, St Louis, Missouri, USA.; Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA.; Division of Gastroenterology and Hepatology, Presbyterian Hospital, Albuquerque, New Mexico, USA.; Gastro Health, Birmingham, Alabama, USA.; Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.; RMG Gastroenterology, Raleigh, North Carolina, USA.; Division of Gastroenterology, Duke University, Durham, North Carolina, USA.; Division of Gastroenterology, Maimonides Medical Center, SUNY Downstate University, Brooklyn, New York, USA.; Division of Digestive Diseases, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.; Division of Gastroenterology and Hepatology, Loma Linda University, Loma Linda, California, USA.; Basil I. Hirschowitz Endoscopic Center of Excellence, Division of Gastroenterology & Hepatology, Department of Internal Medicine, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA.; Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.; Division of Digestive and Liver Diseases, Veterans Affairs North Texas Health Care System, University of Texas Southwestern Medical Center, Dallas, Texas, USA.; Division of Gastroenterology, University of Washington, Seattle, Washington, USA.; Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.; Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas, USA.; Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, USA.

DOI: 10.1016/j.gie.2023.07.019

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MeSH Terms: Humans, Prospective Studies, Endoscopic Ultrasound-Guided Fine Needle Aspiration, Microscopy, Confocal, Pancreatic Cyst, Lasers