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不同频率实施ERCP医生间的个体与实践差异:一项全国性调查

发布日期:2014-1-29 12:40:13 文章来源:GIE(July,2011) 作者次数:1173
    不同频率实施ERCP医生间的个体与实践差异:一项全国性调查
     
    背景
    美国多数人不知道ERCP实施模式。
     
    目的
    按年度病例量表征美国胃肠病专家ERCP实践特征,病例量评分分为:大量(HV, >200),中等量(MV, 50-200),少量(LV, <50)。
     
    设计方案
    匿名电子问卷调查
     
    研究对象
    美国胃肠内镜学会执业胃肠病专家
     
    结果
    共有1006名调查答复者,这些人中63% 是来自于社区诊所。根据实施ERCPs操作的医生提供的年度病例量(n = 669),他们被分为少量(LV)(n = 254),中等量(MV)(n = 284), 大量(HV)(n = 131)三组。调查期间,未完成180个ERCPs的医生占各组比例:LV为77%, MV为58%,HV为 34% (P < .0001)。相对于乐于操作ERCP的MV(88%)与HV医生(98%),LV医生中仅有58% (P < .0001);报告中感到操作“非常舒服” LV医生有60%,然而另两组均已超过90%(P < .0001)。与MV(92%)和HV(98%)相比,在胰管支架置入(PDS)和用它预防时LV医生感到更不舒服(57%)(P ≤ 0.02)。虽然看起来HV医生是最不可能使用短丝设备的,但是结果显示线导插管的使用率差不多(74% LV, 72% MV, 66% HV, P = 0.13)。与75%的MV和99%的HV相比较,只有37%的LV医生报告在实施针刀括约肌切开术时他们感到舒适(P < .0001)。
     
    局限性
    问卷调查完成率为18.5%
     
    结论
    LV医生自我报告的舒适和/或愉快性更低。尽管大多数ERCP执业医生都会使用线导插管,但LV医生很少使用预防性PDS。因为多数LV医生只会给有高度适应症的实施ERCP,而且他们采用先进技术,比如针刀括约肌切开术,所以还是有必要对LV医生实施ERCP的结果数据作进一步调查统计。
     
    缩写:ASGE为美国胃肠内镜学会,HV为大量, LV为少量,MV为中等量,NKS为针刀括约肌切开术,PDS为胰胆管支架置入术,WGC线导插管。
     
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    Individual and practice differences among physicians who perform ERCP at varying frequency: a national survey

    Background
    ERCP practice patterns in the United States are largely unknown.
     
    Objective
    To characterize the ERCP practice of U.S. gastroenterologists, stratified by their annual case volume: high volume (HV, >200), moderate volume (MV, 50-200), and low volume (LV, <50).
     
    Design
    Anonymous electronic survey.
     
    Subjects
    American Society for Gastrointestinal Endoscopy members who are practicing U.S. gastroenterologists.
     
    Results
    Among all responders (N = 1006), 63% were derived from community practices. Physicians who performed ERCPs and provided data on annual volume (n = 669) were classified as LV (n = 254), MV (n = 284), and HV (n = 131). During training, 77% of LV physicians did not complete 180 ERCPs compared with 58% of MV and 34% of HV physicians (P < .0001). Only 58% of LV physicians enjoy performing ERCP compared with 88% of MV and 98% of HV physicians (P < .0001); 60% reported being “very comfortable” with ERCP compared with more than 90% of MV and HV physicians (P < .0001). LV physicians are less comfortable with pancreatic duct stenting (PDS) (57% vs 92% [MV] and 98% [HV], P ≤ .02) and using prophylactic PDS. Although HV physicians (42%) were least likely to use short-wire devices (P < .02), use of wire-guided cannulation was similar (74% LV, 72% MV, 66% HV, P = .13). Thirty-seven percent of LV physicians reported comfort with needle-knife sphincterotomy compared with 75% (MV) and 99% (HV) (P < .0001).
     
    Limitations
    Survey completion rate of 18.5%.
     
    Conclusions
    Self-reported comfort and/or enjoyment with ERCP is lower among LV physicians. Wire-guided cannulation is used by the majority of all ERCP practitioners, but prophylactic PDS is less frequently used by LV physicians. Because many LV physicians perform ERCP for higher-grade indications and use advanced techniques (eg, needle-knife sphincterotomy), further LV physician ERCP outcomes data are needed.
     
    Abbreviations: ASGE, American Society for Gastrointestinal Endoscopy, HV, high volume, LV, low volume, MV, moderate volume, NKS, needle-knife sphincterotomy, PDS, pancreatic duct stenting, WGC, wire-guided cannulation.
     
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