Browsing by Author "Kayal, Ahmed"

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    Colorectal Endoscopic Mucosal Resection Curriculum Development
    (2021-10-24) Kayal, Ahmed; Heitman, Steven J; Coderre, Sylvain; Raman, Maitreyi; McLaughlin, Kevin
    ABSTRACTBackground and aimsEndoscopic mucosal resection (EMR) is a commonly performed procedure that is not systematically taught during most training programs. The aim of this study was to evaluate the effectiveness of a one-day didactic and simulation-based EMR curriculum for practicing endoscopists without prior formal training in advanced endoscopic tissue resection.MethodsWe designed a one-day lecture and simulation-based EMR course. Twelve participants completed the course. Effectiveness and clinical utility were evaluated using sequential explanatory mixed methods. All participants completed a pre-course multiple-choice-question (MCQ) examination followed by a different, but thematically similar, post-course MCQ examination. A survey was also conducted to assess cognitive fatigue, perceived benefit, and potential for change in EMR practice. Finally, a delayed MCQ examination was administered 10-14 weeks later to assess knowledge retention and qualitative data were sequentially collected from three candidates via semi-structured interviews.ResultsThe mean pre-course score was 47.8% (SD 12.4%). The mean post-course score was 75% (9.9%) and mean delayed score 70.8% (13.6%), both significantly higher than the mean pre-course score (P <0.001; Cohen’s d = 1.86 and P <0.001; Cohen’s d = 1.47, respectively). There was no significant difference between the mean post- and delayed-course test scores (P =130.2). Three themes emerged from the interviews: (1) a need for EMR training, (2) improved knowledge evaluating polyps and (3) changed or refined EMR technique after the course.ConclusionsThis study highlights the need for formal education in EMR and demonstrates significant knowledge acquisition and retention of EMR cognitive skills.
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    Infection control in ERCP using a duodenoscope with a disposable cap (ICECAP): rationale for and design of a randomized controlled trial
    (2020-03-12) Forbes, Nauzer; Elmunzer, B. J; Allain, Thibault; Chau, Millie; Koury, Hannah F; Bass, Sydney; Belletrutti, Paul J; Cole, Martin J; Gonzalez-Moreno, Emmanuel; Kayal, Ahmed; Kumar, Puja; Mohamed, Rachid; Turbide, Christian; Buret, Andre G; Heitman, Steven J
    Abstract Background Endoscopic retrograde cholangio-pancreatography (ERCP) is commonly performed in the management of pancreatic and biliary disease. Duodenoscopes are specialized endoscopes used to perform ERCP, and inherent to their design, a high rate of persistent bacterial contamination exists even after automated reprocessing and disinfection. Consequently, in recent years, ERCP has been associated with infection transmission, leading to several fatal patient outbreaks. Due to increasing fears over widespread future duodenoscope-related outbreaks, regulatory bodies have called for alterations in the design of duodenoscopes. A duodenoscope has recently been developed that employs a disposable cap. This novel design theoretically eliminates the mechanism behind persistent bacterial contamination and infection transmission. However, there are no data demonstrating persistent bacterial contamination rates, technical success rates, or clinical outcomes associated with these duodenoscopes. Methods A parallel arm randomized controlled trial will be performed for which 520 patients will be recruited. The study population will consist of consecutive patients undergoing ERCP procedures for any indication at a high-volume tertiary care centre in Calgary, Alberta, Canada. Patients will be randomized to an intervention group, that will undergo ERCP with a novel duodenoscope with disposable cap, or to a control group who will undergo ERCP with a traditional duodenoscope. Co-primary outcomes will include persistent bacterial contamination rates (post automated reprocessing) and ERCP technical success rates. Secondary outcomes include clinical success rates, overall and specific early and late adverse event rates, 30-day mortality and healthcare utilization rates, procedure and reprocessing times, and ease of device use. Discussion The ICECAP trial will answer important questions regarding the use of a novel duodenoscope with disposable cap. Specifically, persistent bacterial contamination, technical performance, and relevant clinical outcomes will be assessed. Given the mortality and morbidity burden associated with ERCP-related infectious outbreaks, the results of this study have the capacity to be impactful at an international level. Trial registration This trial was registered on clinicaltrials.gov (NCT04040504) on July 31, 2019.