Abstract
Aim:No established educational program exists for endoscopic injection sclerotherapy (EIS). At our institution, endoscopists inexperienced in intravariceal injection perform paravariceal injection as training for intravariceal injection. This study investigated whether paravariceal injection was useful as training for intravariceal injection in EIS. Moreover, this study examines the learning curve of intravariceal injection to determine the necessary number of procedures to become proficient in EIS.
Methods:Eight endoscopists who had 5-10 years' endoscopy experience were enrolled from October 2000 to September 2007. They performed paravariceal injection as training for intravariceal injection ; they then performed intravariceal injection on 147 patients in 259 sessions. We assessed whether there was any correlation between the number of paravariceal injections before intravariceal injection and the success rate of the first 10 intravariceal injection procedures. Moreover, success and complication rates by the endoscopists who had performed 1-30 intravariceal injection procedures were compared to those who had performed more than 30.
Results:The average number of paravariceal injections experienced before intravariceal injection and the success rate of the first 10 intravariceal injections were 15.9 sessions (8-31 sessions) and 76.3% (50-100%), respectively. They were positively correlated (rs=0.653, p=0.079). The relationship between the number of performed intravariceal injections and their success rates were studied on 259 intravariceal injection sessions. The endoscopists were divided into 6 groups according to their experienced number of intravariceal injection by 10 procedures. The success rates in the groups were 76.3%, 76.1%, 68.8%, 90%, 89.3%, and 86.4%, respectively. The average success rates in the endoscopists who had performed 1-30 intravariceal injections and more than 30 were 74.9% and 88.8%, respectively. A significant difference was found between two groups (p=0.011). The overall complication rate was 28.6%. No significant difference was found in the complication rate between the two groups.
Conclusion:Paravariceal injection seems to be a useful training for intravariceal injection. It can be said that experience of 30 intravariceal injection procedures will contribute to secure and stable intravariceal injections.
