Do gastroenterologists want to be trained in ultrasound? A national survey of trainees in gastroenterology

Referrals for bowel ultrasound in clinical practice: a survey in 12 nationwide centres in Italy

BACKGROUND

The value of ultrasound (US) in assessing gastrointestinal diseases is well documented, but its demand in clinical practice is unknown. This survey evaluated the demand for bowel US in Italy.

METHODS

Twelve sonographers of the Gastroenterology Section of the Italian Society of Ultrasound participated in a 1-month survey; they compiled a questionnaire assessing total number of patients referred for abdominal US and for gastrointestinal tract US, type of referring physician, indications and results of examinations.

RESULTS

The survey included 2424 examinations, 586 of which (24%) investigated the gastrointestinal tract: 280 for signs or symptoms and 268 for follow-up of pre-existing gastrointestinal diseases. Referring physicians were mainly gastroenterologists (78%) and general practitioners (13%). Organic lesions were found or suspected in 292 examinations.

CONCLUSIONS

Bowel US is used in Italy in routine practice, mainly by gastroenterologists and general practitioners, both for follow-up of pre-existing diseases and for gastrointestinal complaints.

Focused bedside ultrasonography by clinicians: experiences with a basic introductory course

OBJECTIVE

Ultrasonography (US) performed by clinicians might shorten workout time and diminish the workload of simple diagnostic procedures for physicians specialized in US. The purpose of this follow-up study was to evaluate the effect of an introductory course in US on participants' clinical behaviour and course compliance.

MATERIAL AND METHODS

The course consisted of a combined didactic, hands-on, one-day course including a skills test and a review of 20 still-pictures of pathological findings for final authorization. A questionnaire focusing on pre- and post-course activity and its impact on clinical behaviour was sent to 162 participants.

RESULTS

The response rate was 64% (103). Forty-eight (47%) participants changed their clinical approach, 45 (44%) their workout programme and 25 (24%) the pattern of referral. Eleven (10%) sent in the required pathological findings for final authorization. Thirty-four (33%) participants did not carry out US after the course; 19 did not have access to US apparatus, 7 claimed that they lacked the time, 6 lacked supervision and 1 participant cited insufficiency of the course. Clinical approach was changed by 48 (47%), acute workout by 45 (44%) and pattern of referral by 24 (23%).

CONCLUSIONS

Clinicians appear to be ready to change the patterns of their workout programmes and clinical approach after a combined didactic and hands-on introduction to US, but only 10% produced the recommended documentation for authorization. National guidelines need to be introduced for gastroenterologists and surgeons or the European Federation of Societies for Ultrasound in Medicine and Biology Guidelines should be implemented.

Percutaneous liver biopsy in clinical practice

Percutaneous liver biopsy (PLB) is the standard procedure for obtaining hepatic tissue for histopathological examination, and remains an essential tool in the diagnosis and management of parenchymal liver diseases. The use of liver biopsy (LB) is increasing with the advent of liver transplantation and the progress being made in antiviral therapeutic agents. While blind percutaneous needle biopsy is the traditional technique, the use of ultrasound (US) guidance has increased considerably. Literatures were reviewed to assess the existing clinical practice of PLB with an emphasis on the technique, the operator, types of biopsy needles, quality of LB specimens and the risk of complications. The best available evidence indicates that the use of ultrasound-guided biopsy (UGB) is superior to blind needle biopsy (BNB). The odds ratios of the controlled studies showed that BNB carried a higher risk for major complications, postbiopsy pain and biopsy failure. Therefore, percutaneous LB under US control is superior to BNB and it is recommended that UGB be considered the standard of care for this important and widely used invasive procedure in the field of clinical hepatology.