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Impact of balloon inflation on the insertion of endoscopic ultrasound: a prospective, randomized controlled trial.

ABSTRACT: Background and study aims ?During endoscopic ultrasound (EUS), patients may experience severe discomfort. The radial echoendoscope has a balloon around its tip. Balloon inflation prior to insertion may reduce contact injury and pharyngeal pain. The purpose of this study was to investigate the effect of balloon inflation on pharyngeal pain during insertion. Patients and methods ?Patients who underwent radial EUS for pancreatobiliary disease were randomized into standard insertion or balloon-inflated insertion. The primary outcome was the proportion of moderate-to-severe pharyngeal pain. Secondary outcomes were the degree of pharyngeal pain, risk factors for moderate pharyngeal pain, procedure-related adverse events, and pharyngeal pain depending on the experience of the endoscopist. Results ?A total of 481 patients were randomized into two groups: standard insertion (238) and balloon inflation (243). No statistically significant differences in proportion of moderate-to-severe pain were found (26.5?% vs. 20.2?%, P ?=?0.107). Balloon inflation (HR 0.65; 95?% CI (0.42-0.98, P ?=?0.041) was a protective factor against moderate pain. Balloon inflation reduced the proportion of patients with moderate-to-severe pain when performed by physicians with less than 3months of experience with EUS (44.7?% vs. 25.3?%, P ?=?0.012). Conclusion ?Balloon inflation did not reduce the absolute degree of post-procedural pain with EUS, but it reduced the number of patients with moderate-to-severe pain when performed by physicians with less than 3 months of experience.

SUBMITTER: Kang J

PROVIDER: S-EPMC7055621 | biostudies-literature | 2020 Mar

REPOSITORIES: biostudies-literature

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Impact of balloon inflation on the insertion of endoscopic ultrasound: a prospective, randomized controlled trial.

Kang Jinwoo J Lee Sang Hyub SH Lee Jae Woo JW Jang Dong Kee DK Choi Jin Ho JH Choi Young Hoon YH Paik Woo Hyun WH Ahn Dong-Won DW Jeong Ji Bong JB Ryu Ji Kon JK Kim Yong-Tae YT

Endoscopy international open 20200221 3

<b>Background and study aims</b> During endoscopic ultrasound (EUS), patients may experience severe discomfort. The radial echoendoscope has a balloon around its tip. Balloon inflation prior to insertion may reduce contact injury and pharyngeal pain. The purpose of this study was to investigate the effect of balloon inflation on pharyngeal pain during insertion. <b>Patients and methods</b> Patients who underwent radial EUS for pancreatobiliary disease were randomized into standard insertion or ...[more]

PMID: 32140561

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Project description:IntroductionTeaching procedural skills in medicine is time- and resource-intensive, and it is therefore important to determine which educational strategies are most effective. Test-enhanced learning (TEL) has been demonstrated to be effective in improving learner retention; however, there is little research evaluating the testing effect on the acquisition of procedural skills in medicine. The objective of this study was to examine the impact of TEL on learning ultrasound-guided intravenous (USG IV) insertion on a simulated model.MethodsWe conducted a prospective randomized controlled trial of medical students at a single tertiary care academic hospital. Participants were randomized to either the TEL group (TEG) or control group (CG). Each group received an USG peripheral IV teaching session that included a didactic portion and hands-on skills training. The training sessions were identical except that the TEG was informed at the outset that there would be an assessment at the end of the session. The TEG then received a formal assessment of the skill during the last 15 minutes of the session, whereas the CG had continued practice time. Subjects in both groups were evaluated 10-14 days later to compare skill performance using a simulation-based assessment tool consisting of a global rating scale (GRS) and checklist items.ResultsThirty medical students completed the study, 15 in the TEG and 15 in the CG. There were no significant differences between the two groups at baseline based on year of medical training or prior IV or ultrasound experience. The overall procedural success rate was 93.3% (95% CI = 79.0%-100.0%) in the TEG and 80.0% (95% CI = 57.1%-100%) in the CG (p = 0.60). The first-attempt failure rate was 13.3% (95% CI = 0.0%-32.8%) in the TEG and 33.3% (95% CI = 6.3%-60.4%) in the CG (p = 0.39). There were no statistically significant differences between the means of the GRS (TEG = 4.7, CG = 4.2; p = 0.53, r = 0.11) or checklist scores (TEG = 78.6%, CG = 75.3%; p = 0.20, r = 0.24).ConclusionsIn this study of novice learners, both TEL with structured practice and structured practice alone lead to high success rates performing USG IV insertion on a simulated model. While we noted a trend toward higher procedural success rates and lower first-attempt failure rates in the TEG, these did not meet statistical significance. Further studies with larger sample sizes are required to determine whether the beneficial effects of TEL can be transferred to procedural skills teaching.

Project description:PurposeThe use of Virtual Reality (VR) in health professions education has increased dramatically in recent years, yet there is limited evidence of its impact on educational outcomes. The purpose of the study was to assess the impact of VR anatomy instruction on the ultrasound competency of novice learners participating in a ultrasonography workshop.MethodWe designed a VR-enhanced ultrasonography training program and utilized a plane transection tool to interact with a three-dimensional (3D) VR model of the human body which facilitated the 3D conceptualization of the spatial relationship of anatomical structures, leading to faster and better development of ultrasonographic competency. This was a randomized control study which enrolled third-year medical students (n = 101) without previous exposure to formal or informal ultrasonography training. The participants were randomly divided into an intervention and control group. We assessed participants' competency through ultrasound performance stations on live subjects, we also measured anatomical and ultrasound image identification ability using multiple choice tests.ResultParticipants in the intervention group (median = 16; interquartile 13 to 19) had significantly higher scores in ultrasonography task performance tests than the control group (median = 10; interquartile 7 to 14; Mann-Whitney U = 595; P < 0.01). In sub-group analysis, the intervention group performed significantly better in the six out of ten ultrasound tasks. Participants in the intervention group also had greater improvement in ultrasonographic image identification MCQ tests than the control group (Mann-Whitney U = 914; P < 0.05).ConclusionThis study suggests that VR-enhanced anatomical training could be of significant benefit in ultrasonography training by promoting a better understanding of the spatial relationships of anatomical structures and the development of early psychomotor skills transferable to the handling of ultrasonographic probes.

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Impact of balloon inflation on the insertion of endoscopic ultrasound: a prospective, randomized controlled trial.

Publications

Impact of balloon inflation on the insertion of endoscopic ultrasound: a prospective, randomized controlled trial.

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