How safe is EUS performed by an endosonographer trained at a North American advanced training program recognized by ASGE and has met the ASGE guidelines for EUS competency? Results from the first 100 procedures performed after training

Aim: To determine the safety of EUS when performed by the “relatively inexperienced“ endosonographer who has completed advanced training in EUS at a North American training program recognized by ASGE and has met ASGE guidelines for EUS competency.

Methods: The first 100 EUS procedures were performed at a University hospital in '04-'05. Intravenous antibiotics were administered prior to the procedure if fine needle aspiration (FNA) of a cystic lesion was contemplated. A complication that occurred during the procedure or in the recovery period was recorded. All patients were contacted by telephone the following day, to enquire about symptoms. The patient's medical records were reviewed to document a complication within 30 days following the procedure.

Results: The male:female ratio was 0.85. The median age of the patients was 53. There were 90 upper EUS and 10 lower EUS procedures.87 procedures were performed with conscious sedation, 6 with anesthesia and 7 without sedation.25 procedures included FNA. No major cardio-respiratory complications requiring resuscitation were noted. No major bleeding complications were noted. There was no evidence of pancreatitis or infection following the procedures. There was one case of duodenal perforation identified immediately following intubation of the duodenum with the linear echoendoscope, in a 90 year old female with a pancreatic head mass.

Conclusions: 1. EUS is safe when performed by an endosonographer who has just completed advanced training in EUS at a North American training program recognized by ASGE and who has met ASGE guidelines for EUS competency. 2. EUS poses a greater risk in the elderly and should be performed only if it will improve patient outcome. 3. A multicenter study which involves recently trained endosonographers from ASGE recognized advanced training programs in North America is needed to further validate the safety of EUS.