SAN DIEGO – Exposure to endoscopy is generally low among surgical trainees, yet most bariatric surgeons continue to perform endoscopy and manage complications, responses to a survey indicate.
"There is a varying amount of endoscopic training during surgical residency and fellowship, and endoscopic practices are not standardized," Dr. Bipan Chand said at the annual meeting of the American Society for Metabolic and Bariatric Surgery. "Surgeons today perform varying degrees of endoscopy, pre- and postoperatively, as well as diagnostic and therapeutic procedures."
Dr. Chand and his associates sent a 19-question online survey to 1,670 active surgeon members of the ASMBS during a 1-month time frame in an effort to "obtain a better understanding on the current amount of exposure to endoscopy, to obtain information on the amount of diagnostic and therapeutic procedures being performed, by whom and [what the] the comfort level [is]."
Of the 1,670 members, 291 (17%) completed the survey, said Dr. Chand, director of metabolic surgery and bariatric care at Loyola University, Chicago. The largest proportion of respondents (30.9%) were more than 15 years removed from surgical training, whereas 18.9% were 11-15 years removed, 23.4% were 6-10 years removed, 23.4% were 1-5 years removed, and 3.4% were less than 1 year removed.
Nearly 60% of respondents completed a postresidency fellowship. Of these, 38% completed a fellowship in bariatric surgery with an emphasis in minimally invasive surgery (MIS), and 31% completed a fellowship in general MIS.
Dr. Chand, who chairs the ASMBS Emerging Technology and Procedures Committee, reported that during their combined residency and fellowship training, 25% of respondents performed fewer than 25 diagnostic procedures and 55% performed fewer than 5 therapeutic procedures such as dilation and treatment of bleeding.
After completing their training, 41% of respondents reported performing routine preoperative endoscopy for primary bariatric procedures, and 90% reported performing routine preoperative upper endoscopy for revisional bariatric procedures. More than 70% of these procedures were being done by the respondents or by their surgical partners.
Overall, 49% of respondents said they felt "very comfortable" with endoscopic management of bariatric complications, including bleeding, dilation of strictures, removal of foreign bodies, and stent placement.
More than three-quarters of respondents (78%) expressed interest in additional endoscopy training via postgraduate courses, particularly those related to advanced training techniques, whereas 53% and 56%, respectively, predicted that endoscopic procedures will play a role as primary and revisional endoluminal bariatric therapies.
More than two-thirds of surgeons (69%) said that they plan to increase the amount of endoscopy in their practice. "The ASMBS will continue to offer training labs to surgeons to help [them] acquire and refine these important skills," Dr. Chand said. "One such lab was offered at this year’s annual meeting."
Dr. Chand said that he had no relevant financial conflicts to disclose.