The learning curve for transoral incisionless fundoplication

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...

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Autores principales:	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, Marcia Irene Canto
Formato:	article
Lenguaje:	EN
Publicado:	Georg Thieme Verlag KG 2021
Materias:	Diseases of the digestive system. Gastroenterology RC799-869
Acceso en línea:	https://doaj.org/article/3073b6a7fb034550a1dae9b8775f2613
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spelling	oai:doaj.org-article:3073b6a7fb034550a1dae9b8775f26132021-11-13T00:00:31ZThe learning curve for transoral incisionless fundoplication2364-37222196-973610.1055/a-1547-6599https://doaj.org/article/3073b6a7fb034550a1dae9b8775f26132021-11-01T00:00:00Zhttp://www.thieme-connect.de/DOI/DOI?10.1055/a-1547-6599https://doaj.org/toc/2364-3722https://doaj.org/toc/2196-9736Background 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 < 0.0001). TIF procedures time varied until the 44th procedure, after which it decreased significantly from 53.7 minutes to 39.4 minutes (P < 0.0001). Conclusions 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.Mohamad DboukOlaya I. Brewer GutierrezBijun Sai KannadathJose Valentin CamilionSaowanee NgamruengphongVivek KumbhariMouen KhashabMichael MurrayPeter JanuGlenn IhdeKenneth ChangNirav ThosaniMarcia Irene CantoGeorg Thieme Verlag KGarticleDiseases of the digestive system. GastroenterologyRC799-869ENEndoscopy International Open, Vol 09, Iss 11, Pp E1785-E1791 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Diseases of the digestive system. Gastroenterology RC799-869
spellingShingle	Diseases of the digestive system. Gastroenterology RC799-869 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 Marcia Irene Canto The learning curve for transoral incisionless fundoplication
description	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 < 0.0001). TIF procedures time varied until the 44th procedure, after which it decreased significantly from 53.7 minutes to 39.4 minutes (P < 0.0001). Conclusions 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.
format	article
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 Marcia Irene Canto
author_facet	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 Marcia Irene Canto
author_sort	Mohamad Dbouk
title	The learning curve for transoral incisionless fundoplication
title_short	The learning curve for transoral incisionless fundoplication
title_full	The learning curve for transoral incisionless fundoplication
title_fullStr	The learning curve for transoral incisionless fundoplication
title_full_unstemmed	The learning curve for transoral incisionless fundoplication
title_sort	learning curve for transoral incisionless fundoplication
publisher	Georg Thieme Verlag KG
publishDate	2021
url	https://doaj.org/article/3073b6a7fb034550a1dae9b8775f2613
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The learning curve for transoral incisionless fundoplication

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