CC BY-NC-ND 4.0 · Endosc Int Open 2017; 05(09): E900-E904
DOI: 10.1055/s-0043-115387
Original article
Eigentümer und Copyright ©Georg Thieme Verlag KG 2017

Endoscopic sleeve gastroplasty: the learning curve

Christine Hill
Diversity Summer Internship Program, Johns Hopkins Bloomberg School of Public Health, Baltmore, Maryland, United States
,
Mohamad El Zein
Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland, United States
,
Abhishek Agnihotri
Department of Medicine, Johns Hopkins University of Medicine, Baltimore, Maryland, United States
,
Margo Dunlap
Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland, United States
,
Angela Chang
Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland, United States
,
Alison Agrawal
Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland, United States
,
Sindhu Barola
Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland, United States
,
Saowanee Ngamruengphong
Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland, United States
,
Yen-I Chen
Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland, United States
,
Anthony N. Kalloo
Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland, United States
,
Mouen A. Khashab
Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland, United States
,
Vivek Kumbhari
Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland, United States
› Author Affiliations
Further Information

Publication History

submitted 02 May 2017

accepted after revision 16 June 2017

Publication Date:
13 September 2017 (online)

Abstract

Background and study aims Endoscopic sleeve gastroplasty (ESG) is gaining traction as a minimally invasive bariatric treatment. Concern that the learning curve may be slow, even among those proficient in endoscopic suturing, is a barrier to widespread implementation of the procedure. Therefore, we aimed to define the learning curve for ESG in a single endoscopist experienced in endoscopic suturing who participated in a 1-day ESG training program.

Patients and methods Consecutive patients who underwent ESG between February 2016 and November 2016 were included. The performing endoscopist, who is proficient in endoscopic suturing for non-ESG procedures, participated in a 1-day ESG training session before offering ESG to patients. The outcome measurements were length of procedure (LOP) and number of plications per procedure. Nonlinear regression was used to determine the learning plateau and calculate the learning rate.

Results Twenty-one consecutive patients (8 males), with mean age 47.7 ± 11.2 years and mean body mass index 41.8 ± 8.5 kg/m2 underwent ESG. LOP decreased significantly across consecutive procedures, with a learning plateau at 101.5 minutes and a learning rate of 7 cases (P = 0.04). The number of plications per procedure also decreased significantly across consecutive procedures, with a plateau at 8 sutures and a learning rate of 9 cases (P < 0.001). Further, the average time per plication decreased significantly with consecutive procedures, reaching a plateau at 9 procedures (P < 0.001).

Conclusions Endoscopists experienced in endoscopic suturing are expected to achieve a reduction in LOP and number of plications per procedure in successive cases, with progress plateauing at 7 and 9 cases, respectively.