Background

The COVID-19 pandemic has had a substantial impact on endoscopy training worldwide, due to various factors such as significant decreased case volume and training opportunities. Moreover, the British Society of Gastroenterology had advised on operational considerations during the pandemic such as restricting number of staff in procedure rooms. Aim: We describe a novel training method employed at a single tertiary hospital in the United Kingdom to circumvent such restrictions to minimize disruption to advanced endoscopy training. Herein, we evaluate the impact of this approach on patient safety and outcomes.

Methods

During the acceleration and plateau phase of the pandemic, the number of healthcare professionals was limited to 3 in an endoscopy room during any procedure. Whenever the advanced endoscopy fellow (KS Kok) was training, the trainer acted as the equipment assistant. A nurse was present, managing patient monitoring and airway issues. The number and type of such procedures were assessed, with any intraprocedural and 30 day procedural-related complications evaluated.

Results

Between 30th March to 7th June 2020, the advanced endoscopy fellow was involved in 51 endoscopy cases, including 5 cases where 2 procedures were planned at one time. 40/51 cases were done under conscious sedation, and 11/51 cases were done under general anaesthesia. The types of procedures are described in figure 1. Of the 51 cases, 48 cases were deemed therapeutic. This is an approximate 67% decrease in caseload that the advanced endoscopy fellow would be exposed to compared with numbers pre-pandemic. Technical success in therapeutic cases was achieved in 45/48 (93.8%). 1 patient could not tolerate the procedure under conscious sedation; 2 cases were failed bile duct cannulations at ERCP despite attempts from the trainee and trainer. There were no intraprocedural complications. 2/48 patients were admitted within 30 days of procedure. 1 had mild post ERCP pancreatitis. Another patient was admitted with haematemesis 7 days post-ERCP due to a bleeding oesophageal ulcer which was successfully managed endoscopically. 2 patients died within 30 days of their procedure, both of which were not related to the procedure.

ConclusionThe evaluation of outcomes from this cohort of patients treated during the COVID-19 pandemic, while the trainer worked as the assistant, has shown that this training model allows for hands-on advanced endoscopic training while maintaining efficiency and patient safety. A closer working relationship could be fostered between the trainee and different trainers. The trainer is able to provide more detailed feedback in view of the greater involvement during the procedure. However, one has to mindful that in the long term, this might impact on nursing/assistant training in advanced procedures in the unit.Article InfoIdentification

DOI: https://doi.org/10.1016/j.gie.2021.03.191

Copyright

© 2021 Published by Elsevier Inc.

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