title: Self-training in unsedated transnasal EGD by endoscopists competent in standard peroral EGD: prospective assessment of the learning curve.
abstract: BACKGROUND
  Training programs in unsedated transnasal (UT) EGD are scarce.
  
  
  OBJECTIVE
  To prospectively assess the learning curve for unsupervised UT-EGD.
  
  
  METHODS
  Endoscopy service, without experience in UT-EGD.
  
  
  METHODS
  Consecutive patients referred for diagnostic EGD.
  
  
  METHODS
  UT-EGD was attempted in 140 study patients by 2 endoscopists who trained by themselves in UT-EGD (skilled endoscopist [n = 70]; a trainee having recently achieved competency in conventional EGD [n = 70]) and in 10 controls (endoscopist skilled in UT-EGD) by using a 4.9-mm-diameter videoendoscope.
  
  
  METHODS
  Technical success, sedation administered, patient tolerance acceptance, procedure duration for each decade of 10 consecutive patients investigated by the same endoscopist; intention-to-treat analysis.
  
  
  RESULTS
  Both self-trained endoscopists fulfilled predefined criteria of competency in UT-EGD since the first attempts. They completed examinations of adequate quality with exclusive transnasal scope insertion (n = 139 [99.3%]), no sedation (n = 138 [98.6%]), and patient accepting repeat procedure (n = 135 [96.4%]) in proportions not significantly different from controls for all decades. Compared with a median procedure duration of 5.5 minutes (interquartile range [IQR] 5.0-8.5 minutes) in controls, procedures were significantly longer for all trainee's decades (eg, first decade 20.0 minutes [IQR 15.0-29.0 minutes], P < .001) but none for the skilled endoscopist. Overall discomfort, pain, gagging, and belching were not significantly different for study patients versus controls. Fifty-six of 69 study patients (81%) with a previous history of conventional EGD preferred UT-EGD.
  
  
  CONCLUSIONS
  Generalizability to other small-caliber endoscopes.
  
  
  CONCLUSIONS
  Endoscopists competent in conventional EGD may obtain excellent results with UT-EGD (except for procedure duration) beginning with their first attempts, even without supervision or structured training.
authors.affiliation: Geneva University Hospitals, Geneva, Switzerland.
authors.forename: Massimo
authors.initials: M
authors.lastname: Maffei
authors.forename: Jérôme
authors.initials: J
authors.lastname: Dumortier
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Dumonceau
mesh_terms: D000328:Adult; D002983:Clinical Competence; D004066:Digestive System Diseases / Q000175:diagnosis*; D016145:Endoscopy, Digestive System / Q000009:adverse effects / Q000379:methods; D006801:Humans; D006993:Hypnotics and Sedatives; D009296:Nasal Cavity; D010146:Pain / Q000209:etiology; D017060:Patient Satisfaction; D011214:Practice, Psychological; D011380:Programmed Instructions as Topic; D011446:Prospective Studies; D013997:Time Factors
chemical_list: D006993:Hypnotics and Sedatives