EUS-guided pancreatic drainage: A steep learning curve.
EUS-guided pancreatic drainage
pancreatic stricture
pancreatico-jejunostomy
pancreaticogastrostomy
therapeutic EUS
Journal
Endoscopic ultrasound
ISSN: 2303-9027
Titre abrégé: Endosc Ultrasound
Pays: China
ID NLM: 101622292
Informations de publication
Date de publication:
Historique:
entrez:
26
6
2020
pubmed:
26
6
2020
medline:
26
6
2020
Statut:
ppublish
Résumé
EUS-guided pancreatic drainage (EUS-PD) is an efficacious, acceptable risk option for patients with pancreatic duct obstruction who fail conventional ERCP. The aim of this study was to define the learning curve (LC) for EUS-PD. Consecutive patients undergoing EUS-PD by a single operator were included from a dedicated registry. Demographics, procedural info, adverse events, and follow-up data were collected. Nonlinear regression and cumulative sum (CUSUM) analyses were conducted for the LC. Fifty-six patients were included (54% of male, with a mean age of 58 years). Technical success was achieved in 47 patients (84%). Stent placement was antegrade in 36 patients (77%) and retrograde in 11 (23%). Clinical success was achieved in 46/47 (98%) patients who achieved technical success. Adverse events were seen in 13 patients (6 of whom did not achieve technical success) and included bleeding requiring embolization (n = 5), bleeding treated with clips peri-procedurally (n = 1), pancreatitis (n = 5), and a pancreatic fluid collection drained via EUS-drainage (n = 2). The median procedural time was 80 min (range 49-159 min). The CUSUM chart showed that 80-min procedural time was achieved at the 27 Endoscopists experienced in EUS-PD are expected to achieve a reduction in procedural time over successive cases, with efficiency reached at 80 min and a learning rate of 27 cases. Continued improvement is demonstrated with additional experience, with plateau indicating mastery suggested at the 40
Sections du résumé
BACKGROUND AND OBJECTIVE
OBJECTIVE
EUS-guided pancreatic drainage (EUS-PD) is an efficacious, acceptable risk option for patients with pancreatic duct obstruction who fail conventional ERCP. The aim of this study was to define the learning curve (LC) for EUS-PD.
METHODS
METHODS
Consecutive patients undergoing EUS-PD by a single operator were included from a dedicated registry. Demographics, procedural info, adverse events, and follow-up data were collected. Nonlinear regression and cumulative sum (CUSUM) analyses were conducted for the LC.
RESULTS
RESULTS
Fifty-six patients were included (54% of male, with a mean age of 58 years). Technical success was achieved in 47 patients (84%). Stent placement was antegrade in 36 patients (77%) and retrograde in 11 (23%). Clinical success was achieved in 46/47 (98%) patients who achieved technical success. Adverse events were seen in 13 patients (6 of whom did not achieve technical success) and included bleeding requiring embolization (n = 5), bleeding treated with clips peri-procedurally (n = 1), pancreatitis (n = 5), and a pancreatic fluid collection drained via EUS-drainage (n = 2). The median procedural time was 80 min (range 49-159 min). The CUSUM chart showed that 80-min procedural time was achieved at the 27
CONCLUSION
CONCLUSIONS
Endoscopists experienced in EUS-PD are expected to achieve a reduction in procedural time over successive cases, with efficiency reached at 80 min and a learning rate of 27 cases. Continued improvement is demonstrated with additional experience, with plateau indicating mastery suggested at the 40
Identifiants
pubmed: 32584312
pii: EndoscUltrasound_2020_9_3_175_286585
doi: 10.4103/eus.eus_3_20
pmc: PMC7430898
doi:
Types de publication
Journal Article
Langues
eng
Pagination
175-179Déclaration de conflit d'intérêts
None
Références
Gastrointest Endosc. 2017 Jan;85(1):178-180
pubmed: 27986109
Endoscopy. 2009 Oct;41(10):898-901
pubmed: 19750454
Gastrointest Endosc. 2009 Sep;70(3):471-9
pubmed: 19560768
Gastrointest Endosc. 2007 Feb;65(2):233-41
pubmed: 17258981
Gastrointest Endosc. 2010 Jun;71(7):1166-73
pubmed: 20303489
Gastrointest Endosc. 2012 Dec;76(6):1133-41
pubmed: 23021167
World J Gastroenterol. 2015 Dec 14;21(46):13140-51
pubmed: 26674313
J Hepatobiliary Pancreat Sci. 2015 Jan;22(1):51-7
pubmed: 25385528
Gastrointest Endosc. 2016 Apr;83(4):711-9.e11
pubmed: 26515957
Gastrointest Endosc. 2007 Feb;65(2):224-30
pubmed: 17141775
Gastrointest Endosc. 2012 Jan;75(1):56-64
pubmed: 22018554
Gastrointest Endosc. 2002 Jul;56(1):128-33
pubmed: 12085052
Gastrointest Endosc. 2003 Dec;58(6):919-23
pubmed: 14652566
Zentralbl Chir. 2014 Jun;139(3):318-25
pubmed: 24293122
J Hepatobiliary Pancreat Sci. 2014 Feb;21(2):E4-9
pubmed: 24123911
Dig Endosc. 2013 May;25 Suppl 2:109-16
pubmed: 23617660
Endoscopy. 2011 Jun;43(6):518-25
pubmed: 21437853
Therap Adv Gastroenterol. 2011 Jul;4(4):213-8
pubmed: 21765865
Gastrointest Endosc. 2004 Jan;59(1):100-7
pubmed: 14722561
Gastrointest Endosc. 2015 Apr;81(4):898-905.e1
pubmed: 25442086
J Hepatobiliary Pancreat Surg. 2007;14(4):377-82
pubmed: 17653636
Therap Adv Gastroenterol. 2017 Jan;10(1):42-53
pubmed: 28286558
Gastrointest Endosc. 2017 Jan;85(1):164-169
pubmed: 27460387
HPB (Oxford). 2009 Nov;11(7):565-9
pubmed: 20495708
Gastrointest Endosc. 2013 Dec;78(6):854-864.e1
pubmed: 23891418
Gastrointest Endosc. 2017 Jan;85(1):170-177
pubmed: 27460390
Br J Surg. 2008 Jul;95(7):925-9
pubmed: 18498126