An Assessment Of The Learning Curve For Endoscopic Ultrasound Directed Transgastric Ercp (EDGE) For A Single Operator

Aims We aimed to study the learning curve (LC) of EUS-directed transgastric ERCP (EDGE). EDGE entails the creation of a gastrogastrostomy (GG) through placement of a lumen-apposing metal stent (LAMS).

Methods Retrospective analysis of a prospectively maintained dataset of patients who underwent EDGE by a single operator from 02/2015 to 08/2020. Primary outcome: learning curve for EDGE defined by the number of cases needed to achieve proficiency and mastery. Cumulative sum (CUSUM) analysis was used to assess them in terms of total procedural time (defined as the time for the combined procedure, both EUS and ERCP). The overall mean procedure time was used as the target value.

Results 46 EDGE were performed by the same operator (80 % F, mean age 60yr). Technical success (creation of GG and completion of intended procedure) was achieved in 45 (97.8 %) patients. Most procedures were performed freehand with cautery-assisted LAMS (85 %), and stent size was 15 mm in 21 (46 %) and 20 mm in 25 (54 %) patients. Single-step procedure was performed in 32 (70 %) of cases. Suturing of LAMS was performed in 32 (70 %) patients. The mean procedural time was 87 min. AEs occurred in 7 (15 %) patients, and consisted of bleeding (n = 2), cholangitis (n = 2) and perforation from misdeployment (n = 3), all managed conservatively/endoscopically. LAMS were left in place for a median of 42 days. There was no significant weight gain at the end of follow-up compared to pre-EDGE weight (89 kg vs 91 kg, p = 0.95). On CUSUM analysis, about 15 cases were needed to achieve proficiency, while 27 cases were needed to achieve mastery of the technique. These results were confirmed with the average moving curve.

Conclusions Analysis of the learning curve for EDGE revealed that 15 procedures can be considered the threshold to achieve proficiency and 27 cases to reach mastery of the technique.

Citation Jovani M, Keane MG, Bejjani M et al. eP441 AN ASSESSMENT OF THE LEARNING CURVE FOR ENDOSCOPIC ULTRASOUND DIRECTED TRANSGASTRIC ERCP (EDGE) FOR A SINGLE OPERATOR. Endoscopy 2021; 53: S242.

Publication History

Article published online:
19 March 2021