1. The learning curve for transoral incisionless fundoplication
- Author
-
Mohamad Dbouk, Olaya I. Brewer Gutierrez, Bijun Sai Kannadath, Jose Valentin Camilion, Saowanee Ngamruengphong, Vivek Kumbhari, Mouen Khashab, Michael Murray, Peter Janu, Glenn Ihde, Kenneth Chang, Nirav Thosani, and Marcia Irene Canto
- Subjects
Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background and study aims 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. Patients and methods 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. Results 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 18th to 20th procedure. The maximum efficiency for performing a plication was achieved after the 26th procedure, when mean time per plication decreased to 2.7 from 5.1 minutes (P
- Published
- 2021
- Full Text
- View/download PDF