S1098 Learning Curve of Transoral Incisionless Fundoplication: A Proficiency Study

Abstract

Introduction: Transoral incisionless fundoplication (TIF) is a minimally invasive endoscopic procedure for treatment of gastroesophageal reflux disease. Performing TIF requires unique training to achieve proficiency. This study aims to evaluate the learning curve of performing TIF in relation to patient and procedure-specific characteristics. Methods: This is a retrospective study of consecutive TIF procedures performed by a single experienced gastroenterologist to assess the procedure learning curve. Historical and procedural characteristics were recorded, and the learning curve was estimated by cumulative sum of means (CUSUM) analysis. Proficiency was defined as reliably achieving a procedure length less than 45 minutes. Results: 77 consecutive TIF procedures (68 patients) were included. The average age of patients was 52.35 6 15.74 years (32.4% male). The estimated learning plateaus for procedure time and number of fasteners were 41 minutes and 24 fasteners, respectively. Twelve procedures were required to reliably achieve a procedure length of 45 minutes or less. There was no significant correlation between the length of the TIF procedure and number of fasteners (p50.091) or Hill classification (I vs II/III) (p50.483). There was no relationship between the Hill classification (I vs. II/III) and number of fasteners (p50.475). We observed a significant increase in average number of fasteners used over time from 18.5 6 2.28 during the first quartile of procedures to 29.82 6 4.61 in the last quartile (p50.01). There was no relationship between procedure length, ASA score, number of fasteners, and hospital length of stay. Conclusion: Proficiency in performing TIF in less than 45 minutes can be achieved after independently performing 12 procedures.