背景:治疗性内镜和胃肠病学研究员经常在训练期间参与内镜逆行胰胆管造影术(ERCP)。然而,通常担心受训者的参与可能会增加ERCP相关并发症,主要是因为内窥镜的侧视性质和胰管插管的风险较高。没有具体的证据支持这一概念。本系统评价和荟萃分析旨在调查受训者参与ERCP相关不良事件的结果。
方法:PubMed,EMBASE,谷歌学者,Scopus,从开始到2023年5月31日,我们搜索了WebofScience数据库,以评估定义为成功率的ERCP结果的研究,程序时间,失败的尝试,以及有和没有受训者参与的不良事件。使用随机效应模型进行荟萃分析,异质性使用I2统计量进行评估。
结果:七项研究被纳入最终分析,包括17,088个ERCPs。成功率的合并优势比(POR),受训者和无受训者组的不完整/失败尝试为0.466(95%CI0.13至1.66,I2=97.8%,p=0.239)和3.2(95%CI0.70至14.55),I2=98.5%,p=0.134),分别。见习患者ERCP术后胰腺炎和出血的POR与无受训者组为0.97(95%CI0.76至1.23,I2=0%,p=0.78)和1.3(95%CI0.59至2.83,I2=49%,p=0.54)。两组所有不良事件的POR均为1.028(95%CI0.917至1.152,I2=0%,p=0.636)。令人惊讶的是,手术时间的汇总std平均差为0.217(95%-0.093至0.05,I2=98.5%,p=0.17)。
结论:这项荟萃分析包括7项研究中的17,088例ERCP,证明了与学员参与成功率相关的ERCP结果具有可比性,程序时间,和不良事件。受训人员在适当的教学环境中参与ERCP似乎是安全的,并且不会损害整个过程的成功。
BACKGROUND: Therapeutic endoscopy and gastroenterology fellows often participate in endoscopic retrograde cholangiopancreatography (ERCP) during their training period. However, it is generally feared that
trainee involvement may increase ERCP-related complications, mainly because of the side-viewing nature of the endoscope and the higher risk of pancreatic duct cannulation. There is no concrete evidence to support this notion. This systematic review and meta-analysis aims to investigate the resultsof
trainee participation on adverse events related to ERCP.
METHODS: PubMed, EMBASE, Google Scholar, SCOPUS, and Web of Science databases were searched from inception to 31 May 2023 for studies evaluating the ERCP outcomes defined as success rates, procedure time, failed attempts, and adverse events with and without
trainee participation. A random effect model was used to perform the meta-analysis, and heterogeneity was assessed using the I2 statistics.
RESULTS: Seven studies were included in the final analysis, including 17,088 ERCPs. The pooled odds ratio (pOR) of success rate, incomplete/failed attempts in the
trainee and no
trainee groups were 0.466 (95% CI 0.13 to 1.66, I2 = 97.8%, p = 0.239) and 3.2 (95% CI 0.70 to 14.55), I2 = 98.5%, p = 0.134), respectively. The pOR of post-ERCP pancreatitis and bleeding in the
trainee vs. no
trainee groups was 0.97 (95% CI 0.76 to 1.23, I2 = 0%, p = 0.78) and 1.3 (95% CI 0.59 to 2.83, I2 = 49%, p = 0.54). The pOR of all adverse events in both groups was 1.028 (95% CI 0.917 to 1.152, I2 = 0%, p = 0.636). Surprisingly, the pooled std mean difference for the procedure time was 0.217 (95% - 0.093 to 0.05, I2 = 98.5%, p = 0.17).
CONCLUSIONS: This meta-analysis comprising of 17,088 ERCPs in seven studies demonstrated comparable ERCP outcomes related to trainee participation regarding success rates, procedure time, and adverse events. Trainees\' involvement in ERCP within a proper teaching setting appears safe and does not compromise the overall procedure\'s success.