Department of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
University of Missouri Health System, Columbia, Missouri, USA.
Gastrointest Endosc. 2021 May;93(5):1088-1093. doi: 10.1016/j.gie.2020.09.041. Epub 2020 Sep 28.
EUS-guided gastroenterostomy (EUS-GE) is increasingly used as an alternative to surgery and enteral stent placement to manage gastric outlet obstruction (GOO). However, no data are available on the learning curve (LC) for EUS-GE. Defining the LC is necessary to create adequate subspecialty training programs and quality assurance.
This study is a retrospective analysis of a prospectively maintained dataset of patients who underwent EUS-GE at 1 tertiary referral center. Primary outcome was the LC for EUS-GE defined by the number of cases needed to achieve proficiency and mastery using cumulative sum (CUSUM) analysis. Moving average graphs and sequential time-block analysis were also performed to assess procedural time. Secondary outcomes included efficacy and safety of EUS-GE.
Eighty-seven consecutive patients underwent EUS-GE, mostly for malignant GOO. For consistency, 14 patients were excluded from analysis (noncautery-assisted EUS-GE, 11; surgical anatomy, 3). The same endoscopist performed all procedures using the same freehand technique. Technical success was achieved in 68 of 73 patients (93%). Immediate adverse events occurred in 4 patients (5.5%), whereas late adverse events occurred only in 1 patient (1%), all managed conservatively or endoscopically. All immediate adverse events occurred during the first 39 cases. Clinical success (defined as resuming at least an oral liquid diet within a week) was achieved in 97% of patients. The mean procedural time was 36 minutes (standard deviation, 24). Evaluation of the CUSUM curve revealed that 25 cases were needed to achieve proficiency and 40 cases to achieve mastery. These results were confirmed with the average moving curve and sequential time-block analysis.
We report, for the first time, data on the LC for EUS-GE. About 25 procedures can be considered as the threshold to achieve proficiency and about 40 cases are needed to reach mastery of the technique.
超声内镜引导下胃造口术（EUS-GE）作为手术和肠内支架置入术的替代方法，越来越多地用于治疗胃出口梗阻（GOO）。然而，目前尚无 EUS-GE 学习曲线（LC）的数据。定义 LC 对于创建足够的专业培训计划和质量保证是必要的。
本研究是对一家三级转诊中心进行的 EUS-GE 的前瞻性维护数据集进行的回顾性分析。主要结局是通过累积和（CUSUM）分析确定 EUS-GE 的 LC，定义为达到熟练和掌握所需的病例数。还进行了移动平均图和顺序时间块分析，以评估手术时间。次要结局包括 EUS-GE 的疗效和安全性。
87 例连续患者接受了 EUS-GE 治疗，主要用于恶性 GOO。为了保持一致性，有 14 例患者被排除在分析之外（非电凝辅助 EUS-GE，11 例；手术解剖，3 例）。同一位内镜医生使用相同的徒手技术进行了所有手术。68 例/73 例（93%）患者获得了技术成功。4 例（5.5%）患者发生即时不良事件，而仅 1 例（1%）患者发生迟发性不良事件，均经保守或内镜治疗。所有即时不良事件均发生在最初的 39 例病例中。97%的患者达到临床成功（定义为在一周内至少恢复口服液体饮食）。平均手术时间为 36 分钟（标准差 24 分钟）。CUSUM 曲线评估显示，需要 25 例才能达到熟练程度，需要 40 例才能达到技术掌握程度。这些结果与平均移动曲线和顺序时间块分析一致。
我们首次报告了 EUS-GE 的 LC 数据。大约 25 例手术可以被认为是达到熟练程度的门槛，大约需要 40 例手术才能掌握该技术。
