II Encuentro Latinoamericano CLEUS- Dr Bertrand Napoleon

1. Training in EUS : our challenge B Napoléon, Ecuador 2010

3. Impact of EUS training ? - Accuracy of EUS staging for esophageal cancer improved for T staging from 64 % to 90 % but not for N staging - Short training (2 months) improved FNA accuracy in pancreatic masses from 33 % to 91 % - Significant increase in sensitivity after 30 cases (>80 %) for FNA in pancreatic masses …. Schlick T Surg Endosc 1999; Harewood Gastrointest Endosc 2002 Mertz H Gastrointest Endosc 2004; Eloubeidi Gastrointest Endosc 2005 Value of EUS proportional to the training  ASGE guidelines

4. How many procedures …? Competence in EUS 2001 ASGE 2008 survey of guidelines advanced fellows Muc/submuc lesions 75 90 (50-100) Pancreatico-biliary exam 75 100 (50-150) EUS-FNA 50 70 (25-100) - Experience : 200-250 procedures/y (close to ERCP) - Training : ≥ 6 mths in a center doing > 300 EUS/y Ainsworth Endoscopy 2002; Sivak Gastrointest Endosc 2002, Rosenthal Gastrointest Endosc 2008

10. Who were the teachers ? Gastroenterologists wellknown for their competence, interest, experience in the field of EUS Compagnonage No remuneration Pathologists, surgeons, radiologists

14. 2008 what experience Diagnosis EUS/year Puncture EUS/year Participation of French Club meeting (live/conventionnal)

17. Learning interventional EUS on animal model (pig) One day session, sub group of < 6 fellows Faculty laboratory (experimental surgical room) Marc Barthet, Hôpital Nord,Marseille, France

18. Learning interventional EUS on animal model (pig) Session program : - to follow anatomical structures : mesenteric, portal and celiac vessels, pancreatic gland, bile duct - to perform FNA on lymph nodes in the liver hilum - to perform celiac neurolysis Evaluation : pre and post test  Significant improvement - to follow anatomical structures - to perform : lymph node FNA (time and precision), celiac neurolysis (time)

19. Participation to meetings Participation to the Francophone annual congress of EUS (alternatively theoretical session, live) Participation to live demo of EUS which will be held in Marseille every year In Europe : One specific live course about EUS in Amsterdam (P Fockens) every year EUS as a part of endoscopic live demo (VidéoDigest, courses, UEGW …)

22. Thanks to Gilles Roseau, Marc Barthet and Jean-Michel Godchaux for giving me some results