Dbouk Mohamad, Brewer Gutierrez Olaya I, Kannadath Bijun Sai, Camilion Jose Valentin, Ngamruengphong Saowanee, Kumbhari Vivek, Khashab Mouen, Murray Michael, Janu Peter, Ihde Glenn, Chang Kenneth, Thosani Nirav, Canto Marcia Irene
Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States.
Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States.
Endosc Int Open. 2021 Nov 12;9(11):E1785-E1791. doi: 10.1055/a-1547-6599. eCollection 2021 Nov.
Transoral incisionless fundoplication (TIF) is a safe and effective minimally invasive endoscopic technique for treating gastroesophageal reflux disease (GERD). The learning curve for this technique has not been reported. We studied the learning curve for TIF when performed by a gastroenterologist by identifying the threshold number of procedures needed to achieve consistent technical success or proficiency (consistent creation of TIF valve ≥ 270 degrees in circumference, ≥ 2 cm long) and efficiency after didactic, hands-on and case observation experience. We analyzed prospectively collected data from patients who had TIF performed by a single therapeutic endoscopist within 17 months after basic training. We determined thresholds for procedural learning using cumulative sum of means (CUSUM) analysis to detect changes in achievement rates over time. We used breakpoint analysis to calculate procedure metrics related to proficiency and efficiency. A total of 69 patients had 72 TIFs. The most common indications were refractory GERD (44.7 %) and proton pump inhbitor intolerance (23.6 %). Proficiency was achieved at the 18 to 20 procedure. The maximum efficiency for performing a plication was achieved after the 26 procedure, when mean time per plication decreased to 2.7 from 5.1 minutes (P < 0.0001). TIF procedures time varied until the 44 procedure, after which it decreased significantly from 53.7 minutes to 39.4 minutes (P < 0.0001). TIF can be safely, successfully, and efficiently performed in the endoscopy suite by a therapeutic endoscopist. The TIF learning curve is steep but proficiency can be achieved after a basic training experience and 18 to 20 independently performed procedures.
经口无切口胃底折叠术(TIF)是一种治疗胃食管反流病(GERD)的安全有效的微创内镜技术。该技术的学习曲线尚未见报道。我们通过确定达到持续技术成功或熟练程度(持续创建周长≥270度、长度≥2厘米的TIF瓣膜)所需的手术阈值数量以及在接受教学、实践操作和病例观察经验后的效率,研究了由胃肠病学家进行TIF时的学习曲线。我们分析了一名治疗内镜医师在基础培训后17个月内对患者进行TIF手术的前瞻性收集数据。我们使用均值累积和(CUSUM)分析来确定手术学习的阈值,以检测随着时间推移成功率的变化。我们使用断点分析来计算与熟练程度和效率相关的手术指标。共有69例患者接受了72次TIF手术。最常见的适应症是难治性GERD(44.7%)和质子泵抑制剂不耐受(23.6%)。在第18至20次手术时达到熟练程度。在第26次手术后,胃底折叠术的执行效率达到最高,此时每次折叠的平均时间从5.1分钟降至2.7分钟(P<0.0001)。直到第44次手术,TIF手术时间都有所变化,此后从53.7分钟显著降至39.4分钟(P<0.0001)。治疗内镜医师可以在内镜检查室安全、成功且高效地进行TIF手术。TIF的学习曲线较陡,但在接受基础培训经验以及独立进行18至20次手术后可以达到熟练程度。