Tee Hoi-Poh, How Soon-Hin, Kaffes Arthur J
Hoi-Poh Tee, Arthur J Kaffes, A W Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Camperdown, Sydney, NSW 2050, Australia.
World J Gastrointest Endosc. 2012 Aug 16;4(8):368-72. doi: 10.4253/wjge.v4.i8.368.
To determine the learning curves for antegrade double-balloon enteroscopy (aDBE) and retrograde DBE (rDBE) by analyzing the technical success rates.
A retrospective analysis in a tertiary referral center. This study reviewed all cases from June 2006 to April 2011 with a target lesion in the small-bowel identified by either capsule endoscopy or computed tomography scan posted for DBE examinations. Main outcome measurements were: (1) Technical success of aDBE defined by finding or excluding a target lesion after achieving sufficient length of small bowel intubation; and (2) Technical success for rDBE was defined by either finding the target lesion or achieving stable overtube placement in the ileum.
Two hundred and eighty two procedures fulfilled the inclusion criteria and were analyzed. These procedures were analyzed by blocks of 30 cases. There was no distinct learning curve for aDBE. Technical success rates for rDBE continued to rise over time, although on logistic regression analysis testing for trend, there was no significance (P = 0.09). The odds of success increased by a factor of 1.73 (95% CI: 0.93-3.22) for rDBE. For these data, it was estimated that at least 30-35 cases of rDBE under supervision were needed to achieve a good technical success of more than 75%.
There was no learning curve for aDBE. Technical success continued to increase over time for rDBE, although a learning curve could not be proven statistically. Approximately 30-35 cases of rDBE will be required for stable overtube intubation in ileum.
通过分析技术成功率来确定顺行双气囊小肠镜检查（aDBE）和逆行双气囊小肠镜检查（rDBE）的学习曲线。
在一家三级转诊中心进行回顾性分析。本研究回顾了2006年6月至2011年4月所有经胶囊内镜或计算机断层扫描确定小肠存在目标病变并接受双气囊小肠镜检查的病例。主要观察指标为：（1）aDBE的技术成功定义为在小肠插管达到足够长度后发现或排除目标病变；（2）rDBE的技术成功定义为发现目标病变或在回肠成功放置稳定的外套管。
282例操作符合纳入标准并进行了分析。这些操作按30例一组进行分析。aDBE没有明显的学习曲线。rDBE的技术成功率随时间持续上升，尽管在逻辑回归分析趋势检验中无统计学意义（P = 0.09）。rDBE成功的几率增加了1.73倍（95%可信区间：0.93 - 3.22）。根据这些数据，估计至少需要30 - 35例在监督下的rDBE操作才能实现超过75%的良好技术成功率。
aDBE没有学习曲线。rDBE的技术成功率随时间持续提高，尽管学习曲线无法得到统计学证明。回肠稳定放置外套管大约需要30 - 35例rDBE操作。
