Evaluation of the Learning Curve for Endoscopic Retrograde Appendicitis Therapy (ERAT)

Aims Endoscopic retrograde appendicitis therapy (ERAT) has gained increasing recognition and application as a novel minimally invasive treatment for acute appendicitis. We aimed to analyze the learning curve of ERAT using the experiences of three novice endoscopists.

Methods We conducted a retrospective analysis of 300 consecutive appendicitis patients treated with ERAT from October 2021 to March 2024. All cases were performed by three novice endoscopists with no prior experience in ERAT or ERCP. The cumulative procedure times and Cumulative summation (CUSUM) analysis were conducted for the first 100 consecutive cases of each endoscopist to compare results and identify different stages of the endoscopic competency learning curve.

Results The average procedure time across all cases was 32.7 minutes. CUSUM analysis of procedure times identified three distinct phases: the learning phase (cases 1-30), the plateau phase (cases 31-72), and the proficiency phase (cases 73-100). Average procedure times for these phases were 37.8, 31.6, and 32.1 minutes, respectively (p=0.001). Intubation success rates improved from 92.2% in the learning phase to 98.8% in the proficiency phase (p=0.037). Postoperative pain VAS scores decreased significantly across phases (2.8, 2.39, and 2.15; p<0.001). Hospital stays shortened (1.5, 0.6, and 0.3 days; p<0.001), and recurrence rates dropped from 24.2% to 6.0% (p=0.004).

Conclusions The learning curve for ERAT involves three phases, with improved outcomes and reduced procedure times as experience increases. A certain level of proficiency is achieved after 30 cases, confirming that the technique is straightforward, feasible, and easy to disseminate.

Publication History

Article published online:
27 March 2025