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 Hill1, Mohamad El Zein2, Abhishek Agnihotri3, Margo Dunlap2, Angela Chang2, Alison Agrawal2, Sindhu Barola2, Saowanee Ngamruengphong2, Yen-I Chen2, Anthony N. Kalloo2, Mouen A. Khashab2, Vivek Kumbhari2
  • 1Diversity Summer Internship Program, Johns Hopkins Bloomberg School of Public Health, Baltmore, Maryland, United States
  • 2Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland, United States
  • 3Department of Medicine, Johns Hopkins University of Medicine, Baltimore, Maryland, United States
Further Information

Publication History

submitted 02 May 2017

accepted after revision 16 June 2017

Publication Date:
13 September 2017 (online)


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.