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FellowShip Therapeutic Endoscopy

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Fellowship Course – 1 Year

  • Proper name of the course

    Fellowship in Therapeutic Endoscopy (FTE).

  • Duration of the course

    1 year

  • Eligibility criteria for admission

    DM (GASTROENTEROLOGY) / DNB (Medical Gastroenterology) from an MCI approved institution

Number of seats: 2

  • Selection process

    A total of 2 candidates will be selected for each course. Selection will be based on performance at interview 30%, University level academic merits 20%, publications if any 20% and recommendations from PG teacher 30%

Curriculum For Advanced Gastrointestinal Endoscopy

Program Objectives

During 1 year of the Therapeutic Endoscopy Fellowship, fellow should be able to:
  • Perform diagnostic as well as therapeutic OGD independently
  • Ability to perform colonoscopies independently
  • Understanding basic physics and principles of endoscopy
  • Understand the features of various types of endoscopes and accessories
  • Reprocessing and maintenance of endoscopes and accessories
  • Identify normal and abnormal anatomy in upper as well as lower GI tract
  • ERCP to diagnose and manage patients with a variety of pancreato – biliary disorders
  • Understanding the principles, techniques and complications or conscious sedation/analgesia as well as patient monitoring during and after endoscopy
  • Obtain familiarity with informed consent and medical ethics, and explaining risk of endoscopy to patients
  • Demonstrate proper technique for selective biliary and pancreatic cannulation, endoscopic sphincterotomy,pre- cut sphincterotomy, needle –knife sphincterotomy, stone extraction and prosthesis placement
  • Antibiotic prophylaxis
  • Cognitive understanding of diagnostic/therapeutic procedures interpreting the findings and understanding the clinical indications/contraindications as well as complications
  • Begin the process of overseeing and teaching these skills and techniques to other GI fellows
  • Assist and perform EUS procedures (diagnostic of upper GI and PB cases)
  • Help in integration of endoscopy in diagnosis and management if gastrointestinal and hepatobiliary disorders
  • Training in research
  • Inculcate appreciation of humanistic (cost conscious,caring) and ethical(accountability,integrity)aspects of medicine
  • Develop ability to work as part of a multidisciplinary team

Teaching Scheme

1. Acquire technical skills in performing the following diagnostic/therapeutic procedures, interpreting findings, recognizing and treating complications

Lesion identification and appropriate therapy – adrenaline injection, APC, variceal sclerotherapy, variceal band ligation and cyanoacrylate injection of fundal varices.

  • Luminal dilatation,(achalasia cardia,webs,strictures) Salivary Guillard,Pneumatic, CRE
  • Stent placement – esophageal, small bowel, colonic
  • Nasogastric and nasojejunal tube placement
  • Foreign body removal
  • Pancreatic pseudocyst drainage
  • Side viewing endoscopy
  • PEG
  • Peroperative enteroscopy
  • Biliary sphincterotomy
  • Biliary/pancreatic stenting/NBD
  • Stone extraction (bile duct)
  • Pediatric procedures
  • Motility studies(esophageal/anorectal)
  • 24 Hr pH monitoring

2.Guidelines for Endoscopic Training in procedures:


S.NO Threshold For Assessing Competence Procedure Required NO
1 Esophagogastroduodenoscopy 150
2 Percutaneous endoscopic gastrostomy tube placement and exchange 02
3 Colonoscopy 100
4 Snare polypectomy & hemostasis 10
5 ERCP – biliary and pancreatic duct cannulation, biliary and pancreatic sphicterotomy, biliary and pancreatic stent placement, stone removal, biliary stricture dilatation, nasobiliary drainage tube placement 50
6 Therapy of gastrointestinal bleed including treatment of variceal hemorrhage (5 actively bleeding) 25
7 Non variceal 5
8 Esophageal dilatation (guidewire & through the scope) 20
9 Capsule endoscopy (small bowel) 20

Didactic Training

  • In addition to hands – on training performance of various endoscopic techniques, the curriculum includes a series of lectures, research presentations, etc.
  • The fellow is expected to perform emergency endoscopies and night on call rotation for observing/assisting/performing emergency endoscopies, if 6 needed in addition to routine endoscopies under supervision of respective consultant.
  • The fellow would be responsible for taking regular ward rounds, supervise and guide the residents.
  • See consultations for endoscopy procedures and follow up patients after the procedures.
  • Supervising and teaching basic endoscopy skills to trainees.
  • Regular discussion with radiologist and pathologist.

Conferences

In addition to attending and participating in the daily academic programme of the department, fellow will be responsible for presenting at various conferences and meetings.

Research Training

  • Fellow will have dedicated blocks of time for work on mutually agreed upon research projects.
  • The development of atleast two prospective Endoscopy based studies is required.
  • It is also expected that the fellow will also complete one retrospective study and one review article.
  • Regular meeting will be held between fellows and faculty members to design and conduct research.
  • The advanced fellow is expected to enroll patients who are undergoing procedures into already – approved clinical protocols in which are involved.

Publications And Presentations

  • It is anticipated that each of the prospective studies developed will generate results and information suitable for publication in a major GI subspeciality journal.
  • Two additional critical manuscripts are expected. These may include a major subject review, case report (limited to one only) or a retrospective review.
  • The development of abstracts for atleast two of the major national GI meetings (ISG/SGE/INSLD) also is anticipated.

Evaluation

  • To ensure that adequate knowledge and acquisition of technical skills, performance will be monitored carefully during the course of the programme.
  • The fellow will be evaluated formally by supervising faculty members which include the performance of procedure, interpretation of findings and planning/performance of appropriate therapy on a regular basis and will meet with the head of the department to review these evaluations.
  • These will be recorded in the log book maintained by the candidate
  • At the end of the course there will be:
    a) Practical test: Skill assessment in performing endoscopies
    b) The log book containing documented competence in endoscopic procedures should be approved by the external faculty.

Suggested Reading

Books

  • Practical gastrointestinal endoscopy : The Fundamentals – 6th edition, P.B.Cotton.C.Williams
  • Endoscopy related topics from Sleisenger and Fordtran’s Gastrointestinal and liver disease – Elsevier
  • Robert.H.Hawes : Endosonography (Elsevies, Saunder)
  • Sugano K double balloon endoscopy – Therapy and practice (Springer)
  • M.Classon – Gastroenterological endoscopy (Thieme)
  • Tytgat GWK.Practice of therapeutic endoscopy W.W.Saunders
  • Sivak Gastroenterologic endoscopy (W.B.Saunders)
  • J.H.Siegal – ERCP
  • Barkin – Advanced therapeutic endoscopy (Raven press)
  • Van Dam, Sivak – GI Endosonography (W.B.Saunders)
  • Wilcox – Atlas of clinical GI Endoscopy (W.B.Saunders)
  • Keeffe E.B. – Atlas of GI Endoscopy (current Med. Ins)
  • Klaus – Atlas of GI Endoscopy and pathology (Blackwell)
  • Kenchel – Atlas of colonoscopy (Springer)
  • Messmann H – Atlas of colonoscopy (Thieme)