Learning curve for EUS-guided biliary drainage: What have we learned?

Abstract

Background and Objective: EUS-guided-biliary drainage (EUS-BD) is an efficacious and safe option for patients who fail ERCP. EUS-BD is a technically challenging procedure. The aim of this study was to define the learning curve for EUS-BD. Methods: Consecutive patients undergoing EUS-BD by a single operator were included for a prospective registry over 6 years. Demographics, procedural information, adverse events, and follow-up data were collected. Nonlinear regression and CUSUM analyses were conducted for the learning curve. Technical success was defined as successful stent placement. Clinical success was defined as resolution of jaundice and/or at least a 30% reduction in the pretreatment bilirubin level within a week after placement or normalization of bilirubin within 30 days. Results: Seventy-two patients were included in the study (53% male, mean age 67 years). Technical success was achieved in 69 patients (96%). Clinical success was achieved in 59/69 patients (86%). Seven patients (10%) had adverse events including bleeding ( n = 6) and liver abscess ( n = 1). The median procedural time was 59 min (range 36–138 min). This was achieved at the 32 nd procedure. Procedural durations were further reduced to 50 min and below after the 50 th procedure in a nonlinear pattern. This suggests that procedural durations approach a potential plateau after 100 cases. Conclusion: Endoscopists experienced in EUS-BD are expected to achieve a reduction in procedural time over successive cases, with efficiency reached at 59 min and a learning rate of 32 cases. Continued improvement is demonstrated with additional experience, with mastery suggested after approximately 100 cases.

Experience-Related Factors in the Success of Beginner Endoscopic Ultrasound-Guided Biliary Drainage: A Multicenter Study

“…Some studies analyzed the learning curve of EUS-BD of a single operator in a high-volume center [ 21 , 22 ]. They recommend that 7–32 cases are required to achieve stable, successful EUS-BD or a reduction in procedural time [ 21 , 22 , 23 ].…”

“…Some studies analyzed the learning curve of EUS-BD of a single operator in a high-volume center [ 21 , 22 ]. They recommend that 7–32 cases are required to achieve stable, successful EUS-BD or a reduction in procedural time [ 21 , 22 , 23 ]. Another study of 101 patients reported that the first half of enrolled patients had a lower mortality rate than the second half [ 24 ].…”

“…The analysis of the learning curve or the period of gaining EUS-BD experience was reported for some institutions; however, most previous studies were conducted in high-volume centers and performed by a single expert operator. In addition, a learning curve was defined to achieve quicker EUS-BD [ 21 ].…”

Endoscopic ultrasound-guided biliary drainage: Are we there yet?

“…The procedure has a high success rate and fewer complications than other forms of biliary drainage including PTBD and surgical bypass, making it a preferred alternative following failed ERCP. However, a significant learning curve is associated with this procedure, with literature suggesting experienced endoscopists requiring over 30 cases to become efficient and nearly 100 cases before mastering these techniques[ 92 ]. In addition, there is insufficient evidence on the route of choice, and patients with biliary obstruction should be evaluated on a case-by-case basis by an experienced therapeutic endoscopist backed by a multidisciplinary team.…”

The ultrasound use of simulators, current view, and perspectives: Requirements and technical aspects (WFUMB state of the art paper)

“…Traditional time-based progression apprenticeship models for ultrasound training face numerous challenges. [ 80 81 82 83 ] This “see one, do one, teach one” approach falls victim to the aforementioned barriers. Despite these challenges, some medical institutions have committed to comprehensive integration of ultrasound instruction across all years of medical school.…”