Cheyenne C Sonntag, MD1, Ryan M Juza1, Gabriel Arevalo, MD2, Jeffrey M Marks, MD2, Eric M Pauli, MD1. 1Penn State Milton S Hershey Medical Center, 2University Hospitals Cleveland Medical Center
INTRODUCTION: Training in flexible endoscopy remains a critical skill for surgeons, as therapeutic endoscopy procedures continue to evolve and to supplant standard surgical operations. The role of endoscopy across surgical subspecialties is shifting, as endolumenal procedures (like per-oral endoscopic myotomy and endolumenal bariatric interventions) have become commonplace. While surgical residency minimum case volumes are mandated, little is known about the volume of endoscopic procedures surgical fellows participate in. We aimed to characterize the volume of flexible endoscopy cases logged by surgical subspecialty fellows as a measure of endoscopic platform use by surgeons.
METHODS: Operative case logs for fellows enrolled in post-graduate training programs participating in The Fellowship Council were de-identified (no patient or program specific information) and provided for analysis. The case log is an online, mandatory, self-reported collection of all surgeries, procedures and endoscopies performed during fellowship year. All cases listed within the category of “GI Endoscopy” in which the fellow designated their role as “Primary” surgeon for the procedure were further sorted based on subcategory and linked to the year of fellowship graduation. Rigid endoscopy, trans-anal endoscopic procedures, and those in which the fellows roll was “First Assistant” were excluded.
RESULTS: From 2007-2017, a total of 152,102 unique flexible endoscopic procedures were documented by 1,603 individual fellows. Fellowship program classifications included colorectal, minimally invasive, bariatric, hepatobiliary, flexible endoscopy and thoracic surgery. For fellows graduating in 2008, a total of 10,071 flexible endoscopic procedures were recorded among 123 fellows (average 82 procedures per fellow, range 1-633). This included a total of 6,018 diagnostic upper endoscopy, 432 therapeutic colonoscopies, with 577 endoscopic retrograde cholangiopancreatography (ERCP) procedures. Due to case log documentation limits, no percutaneous endoscopic gastrostomy (PEG) or enteral stenting procedures were able to be uniquely recorded. By the graduating class of 2017, flexible endoscopy procedure volume had increased to 16,462 procedures completed by 166 fellows (average 99 procedures per fellow, range 1-1012). This included a total of 12,616 diagnostic upper endoscopy, 808 therapeutic colonoscopies, 471 ERCP, 276 PEG and 205 enteral stenting procedures.
CONCLUSION: Flexible endoscopy procedure volumes appear to be increasing among Fellowship Council matched subspecialty trainees. Further evaluation and analysis of this robust data set and direct comparative analysis of procedural types is warranted to better establish emerging trends.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88614
Program Number: P372
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster