title: Endoscopic ultrasound-guided fine-needle aspiration skill acquisition of gastrointestinal submucosal tumor by trainee endoscopists: A pilot study.
abstract: OBJECTIVE
  Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is an effective method for tissue diagnosis of gastrointestinal submucosal tumors (SMTs) that are difficult to diagnose by standard endoscopic biopsy. However, the learning curve, especially for gastrointestinal SMT, has not been sufficiently established. The aim of our study was to assess the skill acquisition and diagnostic accuracy of EUS-FNA for gastrointestinal SMT in trainee endoscopists in order to elucidate the optimal starting standards of EUS-FNA.
  
  
  METHODS
  We prospectively evaluated 51 EUS-FNA procedures for gastrointestinal SMT between May 2010 and March 2014. The procedure was performed by two trainee endoscopists and two expert endoscopists. We investigated the diagnostic yield of EUS-FNA and the factors associated with the accuracy between the trainee endoscopists and expert endoscopists.
  
  
  RESULTS
  The rate of adequate EUS-FNA materials for histological examination was 86.3%. Although infections occurred in two cases (3.9%), which were managed conservatively, no severe complications were identified. Comparing the trainee endoscopists with expert endoscopists, there was no significant difference in the rate of gaining adequate specimen (76.5% vs. 82.3%, P = 0.4626). However, the mean number of passes of the trainees tended to be more than that of the expert endoscopists (2.1 pass vs. 1.7 pass, P = 0.0511), and lesions located in the middle third of the stomach were the predictive factors for nondiagnostic tumors by the trainee endoscopists (P = 0.0075).
  
  
  CONCLUSIONS
  EUS-FNA for gastrointestinal SMT by trainee endoscopists can be safely performed under the supervision of EUS-FNA expert endoscopists.
authors.affiliation: Department of Gastroenterology, The University of Tokyo, Tokyo, Japan; Center for Epidemiology and Preventive Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Keiko
authors.initials: K
authors.lastname: Niimi
authors.affiliation: Department of Gastroenterology, The University of Tokyo, Tokyo, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Goto
authors.affiliation: Department of Gastroenterology, The University of Tokyo, Tokyo, Japan.
authors.forename: Kazumichi
authors.initials: K
authors.lastname: Kawakubo
authors.affiliation: Department of Gastroenterology, The University of Tokyo, Tokyo, Japan.
authors.forename: Yousuke
authors.initials: Y
authors.lastname: Nakai
authors.affiliation: Department of Gastroenterology, The University of Tokyo, Tokyo, Japan.
authors.forename: Chihiro
authors.initials: C
authors.lastname: Minatsuki
authors.affiliation: Department of Gastroenterology, The University of Tokyo, Tokyo, Japan.
authors.forename: Itsuko
authors.initials: I
authors.lastname: Asada-Hirayama
authors.affiliation: Department of Gastroenterology, The University of Tokyo, Tokyo, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Mochizuki
authors.affiliation: Department of Gastroenterology, The University of Tokyo, Tokyo, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ono
authors.affiliation: Department of Gastroenterology, The University of Tokyo, Tokyo, Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Kodashima
authors.affiliation: Department of Gastroenterology, The University of Tokyo, Tokyo, Japan.
authors.forename: Nobutake
authors.initials: N
authors.lastname: Yamamichi
authors.affiliation: Department of Gastroenterology, The University of Tokyo, Tokyo, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Isayama
authors.affiliation: Department of Gastroenterology, The University of Tokyo, Tokyo, Japan; Department of Endoscopy and Endoscopic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Fujishiro
authors.affiliation: Department of Gastroenterology, The University of Tokyo, Tokyo, Japan.
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Koike
keywords: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA); gastrointestinal submucosal tumors (GI SMTs); skill acquisition