Egd ercp

[nonbilious]

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Ercp and egd's

Strictly the territory of gi guys? It would be nice to have this skill as a surgeon for plenty of reasons, not the least of which being the flake factor of the gi guys, at least at my place (out driving their fancy cars)

At my program it seems colonoscopy is as much as the residents learn with the scope.

 

[Winged Scapula]

Ercp and egd's

Strictly the territory of gi guys? It would be nice to have this skill as a surgeon for plenty of reasons, not the least of which being the flake factor of the gi guys, at least at my place (out driving their fancy cars)

At my program it seems colonoscopy is as much as the residents learn with the scope.

Surgical residents are expected to know how to perform an EGD. I am suprised your program does not offer this.

ERCP is another matter. Most surgical residents I know are not trained in this modality and getting the training can be difficult. I had one attending who was trained in it, so it is possible, and as you note, a nice skill to have given the difficulties at times in getting one done for your patients.

 

[SouthernSurgeon]

Surgical residents are expected to know how to perform an EGD. I am suprised your program does not offer this.

ERCP is another matter. Most surgical residents I know are not trained in this modality and getting the training can be difficult. I had one attending who was trained in it, so it is possible, and as you note, a nice skill to have given the difficulties at times in getting one done for your patients.

Similar set-up at my med school - our hospital has one attending who does ERCP - the surgeons typically send him most of their most difficult cases (usually post-op patients who've had their GI tract rerouted in some way).

 

[nonbilious]

long way off for me but, what could one do to acquire said training as a surgeon?

 

[Smurfette]

If you do a surgery residency, you will get this training. The RRC requirements for surgery residents, starting this year (2009 graduates, so ALL current surgery residents) state that you need 35 upper scopes (EGDs/esophagoscopy and PEGs, bronchs don't count) and 50 lowers (colonoscopies to proximal to the splenic flexure---flex sigs don't count) in order to graduate. Colorectal fellowships have higher requirements (I think 200 c-scopes, as well as minimum numbers of different biopsy techniques and tattoos, etc.), so 'additional' scope training comes as part of that program.

I think in today's world, getting ERCP training as a surgeon will be difficult since GI will want to keep this for themselves. You'd need to find a place with both the volume and without competing GI fellows to get yourself trained.

At my hospital, the GI fellows are not routinely taught ERCPs, as the GI program director told me it is not a RRC program requirement and that *most* GI docs don't do them--there's only 2 in my academic hospital that perform ERCPs, but all the GI guys do EGDs and c-scopes. Any fellows that intend to do them in their practice have a minimum number to do before they can get privileges, but I can't remember the number, and the program will adjust their curriculum to accommodate ERCP training....the learning curve for ERCPs is much more difficult.

 

[nonbilious]

If you do a surgery residency, you will get this training. The RRC requirements for surgery residents, starting this year (2009 graduates, so ALL current surgery residents) state that you need 35 upper scopes (EGDs/esophagoscopy and PEGs, bronchs don't count) and 50 lowers (colonoscopies to proximal to the splenic flexure---flex sigs don't count) in order to graduate. Colorectal fellowships have higher requirements (I think 200 c-scopes, as well as minimum numbers of different biopsy techniques and tattoos, etc.), so 'additional' scope training comes as part of that program.

I think in today's world, getting ERCP training as a surgeon will be difficult since GI will want to keep this for themselves. You'd need to find a place with both the volume and without competing GI fellows to get yourself trained.

At my hospital, the GI fellows are not routinely taught ERCPs, as the GI program director told me it is not a RRC program requirement and that *most* GI docs don't do them--there's only 2 in my academic hospital that perform ERCPs, but all the GI guys do EGDs and c-scopes. Any fellows that intend to do them in their practice have a minimum number to do before they can get privileges, but I can't remember the number, and the program will adjust their curriculum to accommodate ERCP training....the learning curve for ERCPs is much more difficult.

Awesome. Thanks for the info.

 

[deleted89854]

At our place we have a surgical endoscopy service that handles all EGD, ERCP, and colonoscopy on the surgical patients. We see tons of CBD stones, and GI can be slow. That's where we get all of our scopes. I got to cannulate the duct once, but normally the MIS fellow get priority for that one.

Bronchs don't count?

 

[maxheadroom]

I have a friend who did a surgical endoscopy fellowship with the intent of getting lots of ERCP experience. He came back to town and has become the go-to guy for clearing common ducts. He even gets referrals from the competing group because he's technically excellent (he trained here and all the surgeons worked with him when he as a resident), he's super nice, he sees the consult quickly and gets them into the GI Lab either that day or the next, and patients love him. He saw a need in the community (the GI guys were really slow at responding to the consults) and landed himself a great niche.

 

[Smurfette]

At our place we have a surgical endoscopy service that handles all EGD, ERCP, and colonoscopy on the surgical patients. We see tons of CBD stones, and GI can be slow. That's where we get all of our scopes. I got to cannulate the duct once, but normally the MIS fellow get priority for that one.

Bronchs don't count?

No, bronchs don't count.

In the ACGME Op Log, if you go to 'reports' and then the "defined category" report, click to see page 2 (this is new this past year) and it breaks down some categories into subcategories (peds and endoscopy). when you log a bronch, it counts as a miscellaneous endoscopy only, not as part of the 35/50 required.