Status of training in the use of lumen-apposing metal stents for therapeutic endoscopic ultrasound during advanced endoscopy fellowship: a survey questionnaire.

BACKGROUND AND AIMS: The lumen-apposing metal stent (LAMS) has revolutionized endoscopic ultrasound (EUS). However, there is a paucity of data on the optimal approaches to training on the use of LAMSs. This survey study aimed to evaluate the status of training in LAMSs among advanced endoscopy fellowship (AEF) trainees.

METHODS

AEF (academic year 2023-2024) trainees were invited to complete a 15-question survey on LAMS training. The questions included the following domains: demographics, exposure to LAMSs before AEF, number of observed and hands-on participation using LAMSs for EUS-guided pancreatic fluid collection drainage (EUS-PFCD), choledochoduodenostomy (EUS-CD), gallbladder drainage (EUS-GBD), and gastrojejunostomy (EUS-GJ) and EUS-directed transgastric endoscopic retrograde cholangiopancreatography (EDGE). Trainees were asked about their level of confidence in performing these procedures independently upon completion of their AEF.

RESULTS

Forty-three of 92 trainees completed the survey. Trainees reported performing a median of 400 (interquartile range [IQR], 305-525) EUS and 405 (IQR, 345-500) endoscopic retrograde cholangiopancreatography procedures. Most (88.4%) had exposure to hands-on LAMS training in explant/inanimate models during their AEF. More than one-half of trainees (23; 53.5%) reported hands-on participating in >10 EUS-PFCD cases but ≤2 for each of the non-pancreatic fluid collection drainage (PFCD) indications. Although most trainees (88.4%) reported feeling confident in their ability to perform EUS-PFCD independently, only 34.9% and 39.6% indicated being confident for EUS-GJ and EUS-CD, respectively. Trainees who were confident had a significantly greater mean number of hands-on cases during AEF training when compared with their nonconfident counterparts.

CONCLUSIONS

This study demonstrates significant variability in LAMS training exposure during AEF, with few hands-on opportunities for non-PFCD indications. Additional research is needed to establish optimal approaches to training in LAMS procedures.