Technical Competency of the Esophgogastroduodenoscopy (EGD) during the First 50 EGDs: The Training Result of Family Medicine Residents in a University Hospital

Park, Ki Heum; Sung, Nak Jin; Lee, Dong Wook; Jeong, Hwee Soo

Abstract

BACKGROUND
A previous Korean study recommended minimal 50 cases of Esophgogastroduodenoscopy (EGD) to achieve technical competency, based on director's opinion. Therefore, this study was conducted to evaluate the achievement of EGD's technical skills during the first 50 EGD cases.
METHODS
The data were collected from the first 50 EGDs consecutively performed by six family medicine residents trained the EGD procedure in one residency program from 2004 to 2006. Technical competency of the EGD procedure was evaluated in 4 steps divided with anatomical landmarks (the gastroesophageal junction, the antrum, the fundus of the stomach, and the second portion of the duodenum). Authors measured the procedure time of EGDs performed by residents in 4 steps and calculated the rate of success cases satisfied with author's own criteria made by procedure time.
RESULTS
The success rate of EGD procedure in all steps was 26.7% at 10 EGDs, but sharply increased to 80.0% at 30 EGDs, reached 88.0% at 50 EGDs. Fail to perform esophageal intubation and retroversion to the fundus of the stomach was none after 30 EGDs. However, in steps from gastroesphageal junction to the antrum of the stomach and from the antrum of the stomach to the second portion of the duodenum, the failure rate kept up less than 10% during the first 50 EGDs. A statistically significant reduction of the procedure time in success cases was observed between 20 and 30 EGDs in all steps.
CONCLUSION
The technical competency of EGD was achieved approximately 90% during the first consecutive 50 EGDs.