Learning curve for EUS-guided biliary drainage: What have we learned?
| Autor: | Paul R. Tarnasky, Michel Kahaleh, Amy Tyberg, Monica Gaidhane, José Celso Ardengh, Prashant Kedia, Maggie Cheung, Avantika Mishra, Cassandra Craig |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
EUS-guided Technical success CUSUM ERCP medicine Radiology Nuclear Medicine and imaging Adverse effect Biliary drainage Hepatology business.industry biliary stricture Gastroenterology Jaundice medicine.disease biliary drainage Surgery learning curve Learning curve Original Article medicine.symptom Bilirubin levels business EUS-guided biliary drainage Liver abscess |
| Zdroj: | Endoscopic Ultrasound |
| ISSN: | 2303-9027 |
| Popis: | Background and Objective: EUS-guided-biliary drainage (EUS-BD) is an efficacious and safe option for patients who fail ERCP. EUS-BD is a technically challenging procedure. The aim of this study was to define the learning curve for EUS-BD. Methods: Consecutive patients undergoing EUS-BD by a single operator were included for a prospective registry over 6 years. Demographics, procedural information, adverse events, and follow-up data were collected. Nonlinear regression and CUSUM analyses were conducted for the learning curve. Technical success was defined as successful stent placement. Clinical success was defined as resolution of jaundice and/or at least a 30% reduction in the pretreatment bilirubin level within a week after placement or normalization of bilirubin within 30 days. Results: Seventy-two patients were included in the study (53% male, mean age 67 years). Technical success was achieved in 69 patients (96%). Clinical success was achieved in 59/69 patients (86%). Seven patients (10%) had adverse events including bleeding (n = 6) and liver abscess (n = 1). The median procedural time was 59 min (range 36–138 min). This was achieved at the 32nd procedure. Procedural durations were further reduced to 50 min and below after the 50th procedure in a nonlinear pattern. This suggests that procedural durations approach a potential plateau after 100 cases. Conclusion: Endoscopists experienced in EUS-BD are expected to achieve a reduction in procedural time over successive cases, with efficiency reached at 59 min and a learning rate of 32 cases. Continued improvement is demonstrated with additional experience, with mastery suggested after approximately 100 cases. |
| Databáze: | OpenAIRE |
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