PTU-084 Should UK gastroenterologists be trained in transcutaneous liver biopsy?

Introduction The UK Joint Committee of Higher Medical Training Gastroenterology curriculum (Feb 2005) suggests that specialist registrars should be “skilled in liver biopsy”. The Joint Royal College of Physicians Training Board Speciality curriculum for gastroenterology (May 2007) states that “liver biopsy is mandatory for those trainees doing liver subspecialty, however other trainees may have and wish to take the opportunity to learn this technique either while doing their hepatology training or at other points in their training rotation”. Increasingly liver biopsy is performed under ultrasound guidance, which has subsequently reduced trainees9 exposure to the technique. In 2005 we surveyed trainee gastroenterologists and demonstrated a low level of practical experience and theoretical knowledge of transcutaneous liver biopsy. 1 The aim of this study was to establish whether these deficiencies had improved. Methods All gastroenterology SpRs and ST trainees in the Wessex deanery received a questionnaire aimed at assessing practice training in liver biopsy and knowledge of the current BSG guidelines. The results of the survey were compared to previously published data from 2005. Results 66% of the 31 gastroenterology trainees surveyed responded. Similar to 2005, all of the trainees worked in hospitals where liver biopsies were performed exclusively under ultrasound guidance by radiologists. 43% (compared with 54% in 2005) had performed liver biopsy with supervision and only 19% (29% in 2005) were independently competent. Only 19% of trainees felt that either gastroenterologists or herpetologists should be performing transcutaneous liver biopsy. The average number of liver biopsies performed per trainee had dropped from 14.1 in 2005 to 9.7 in 2009. Only 13% of trainees had performed liver biopsy without supervision; a significant drop from 39% in 2005. None of the trainees experienced in liver biopsy had a written record of this. Knowledge of the suggested safe platelet count, INR and complication rates were: Conclusion This survey of gastroenterology trainees demonstrates a low level of practical and theoretical knowledge with respect to transcutaneous liver biopsy. These findings concur with data from 2005 and in fact reveal a decline in the number of liver biopsies performed by trainees and independent competency. If training in liver biopsy is to remain mandatory for hepatology trainees and recommended for gastroenterologists, training in ultrasound is necessary and training should be aligned with that undertaken by radiologists.