Christopher F McNicoll, MD, MPH, MS1, Cory G Richardson, MD2, Charles R St. Hill, MD, MSc, FACS1, Matthew S Johnson, MD3, Lindsay M Wenger, MD1, Nathan I Ozobia, MD, FACS4. 1UNLV School of Medicine, 2Northwest Institute for Digestive Surgery, 3Desert Surgical Associates, 4University Medical Center of Southern Nevada
INTRODUCTION: Training select general surgery residents in diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP) has been successfully implemented, as confirmed by the three practicing surgical endoscopists that have graduated from our institution. We present the follow-up results from the presentation of Poster 141 at the SAGES 2013 Scientific Session, which asked the question: “can surgery residents be trained to perform diagnostic and therapeutic ERCP during their training?”
METHODS AND PROCEDURES: First described by general surgeons (McCune et al. in 1968), ERCP is routinely performed by gastroenterologists. A general surgeon introduced ERCP to our institution in 1985, and began training select general surgery residents in this skill in 2010. SAGES 2013 Poster 141 and 2015 Poster 162 describe our graduated supervised training program from the junior to chief (or fellowship) years. Three residents have completed this program, and two senior residents are currently enrolled. The graduates and residents were contacted in person, via telephone, and via electronic mail to discuss the utilization of ERCP in their practice.
RESULTS: Three general surgery residents who completed this training program are board certified in general surgery, and completed additional fellowship training and certification [(1) Surgical Critical Care/Acute Care Surgery; (2) Surgical Oncology/Hepatopancreatobiliary Surgery; (3) Advanced Gastrointestinal Minimally Invasive Surgery/Bariatric Surgery/Flexible Endoscopy]. Each received credentials to perform diagnostic and therapeutic ERCP from their respective hospitals in Nevada, Minnesota, and Idaho. One continues to teach ERCP to general surgery residents, and another taught the skill to fellows in an advanced endoscopy fellowship. All three continue to use ERCP in their practice (2 to 5 times per month), as they each specialized in a field that utilizes ERCP routinely. Choledocholothiaisis is the most frequent indication, though ERCP is also performed for iatrogenic biliary duct leaks, traumatic biliary or pancreatic duct leaks, chronic pancreatitis, and malignancy.
CONCLUSIONS: Training in esophagogastroduodenoscopy and colonoscopy is required for general surgery residents, but the addition of ERCP to select residents’ training enables them to completely manage their patients' surgical disease. The training of select general surgery residents in this skill has been successful, evidenced by the continued use of ERCP in the practices of three residents who completed this training program at our institution. The decision to train residents in this skill should be left to individual program directors and department chairs. We recommend that residents selected for this additional training should plan to practice in specialties where ERCP can be implemented.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87333
Program Number: P350
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster