University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
University of Virginia Health System, Charlottesville, Virginia, USA.
Gastrointest Endosc. 2016 Apr;83(4):711-9.e11. doi: 10.1016/j.gie.2015.10.022. Epub 2015 Oct 26.
There are limited data on learning curves and competence in ERCP. By using a standardized data collection tool, we aimed to prospectively define learning curves and measure competence among advanced endoscopy trainees (AETs) by using cumulative sum (CUSUM) analysis.
AETs were evaluated by attending endoscopists starting with the 26th hands-on ERCP examination and then every ERCP examination during the 12-month training period. A standardized ERCP competency assessment tool (using a 4-point scoring system) was used to grade the examination. CUSUM analysis was applied to produce learning curves for individual technical and cognitive components of ERCP performance (success defined as a score of 1, acceptable and unacceptable failures [p1] of 10% and 20%, respectively). Sensitivity analyses varying p1 and by using a less-stringent definition of success were performed.
Five AETs were included with a total of 1049 graded ERCPs (mean ± SD, 209.8 ± 91.6/AET). The majority of cases were performed for a biliary indication (80%). The overall and native papilla allowed cannulation times were 3.1 ± 3.6 and 5.7 ± 4, respectively. Overall learning curves demonstrated substantial variability for individual technical and cognitive endpoints. Although nearly all AETs achieved competence in overall cannulation, none achieved competence for cannulation in cases with a native papilla. Sensitivity analyses increased the proportion of AETs who achieved competence.
This study demonstrates that there is substantial variability in ERCP learning curves among AETs. A specific case volume does not ensure competence, especially for native papilla cannulation.
目前有关 ERCP 学习曲线和能力的资料有限。本研究通过使用标准化数据收集工具，旨在通过累积和（CUSUM）分析前瞻性地定义学习曲线并测量高级内镜医师（AET）的能力。
从第 26 次内镜下 ERCP 检查开始，由主治内镜医师对 AET 进行评估，然后在 12 个月的培训期间每进行一次 ERCP 检查评估一次。使用标准化的 ERCP 能力评估工具（采用 4 分制评分系统）对检查进行分级。将 CUSUM 分析应用于 ERCP 操作的各个技术和认知组成部分的学习曲线，（定义成功为得分为 1，可接受和不可接受的失败分别为 10%和 20%）。进行了敏感性分析，改变了 p1 的值，并且使用了对成功的定义较宽松的方法。
共纳入 5 名 AET，总共完成了 1049 次分级 ERCP（平均±SD，209.8±91.6/AET）。大多数病例是为了胆道适应证而进行的（80%）。总的和原发性乳头允许插管的时间分别为 3.1±3.6 和 5.7±4。总的学习曲线显示出个体技术和认知终点的显著差异。尽管几乎所有 AET 都在总体插管方面达到了能力，但在原发性乳头的病例中，没有一个 AET 达到插管能力。敏感性分析增加了达到能力的 AET 的比例。
本研究表明，AET 之间的 ERCP 学习曲线存在很大差异。特定的病例量并不能确保能力，特别是在原发性乳头插管方面。
