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

submitted 02. Mai 2017

accepted after revision 16. Juni 2017

Publikationsdatum:
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.

 
  • References

  • 1 Abu Dayyeh Bk, Acosta A, Camilleri M. et al. Endoscopic sleeve gastroplasty alters gastric physiology and induces loss of body weight in obese individuals. YJCGH Clin Gastroenterol Hepatol 2017; 15: 37-43 .e31
  • 2 Sharaiha RZ, Kedia P, Kumta N. et al. Initial experience with endoscopic sleeve gastroplasty: technical success and reproducibility in the bariatric population. Endoscopy 2015; 47: 164-166
  • 3 Abu Dayyeh BK, Rajan E, Gostout CJ. Endoscopic sleeve gastroplasty: a potential endoscopic alternative to surgical sleeve gastrectomy for treatment of obesity. YMGE Gastrointest Endosc 2013; 78: 530-535
  • 4 Lopez-Nava G, Galvaão MP, da Bautista-Castaño I. et al. Endoscopic sleeve gastroplasty for the treatment of obesity. Endoscopy 2015; 47: 449-452
  • 5 Lopez-Nava G, Galvão M, Bautista-Castao I. et al. Endoscopic sleeve gastroplasty with 1-year follow-up: factors predictive of success. Endoscop Int Open 2016; 4: 222-227
  • 6 Colquitt JL, Pickett K, Loveman E. et al. Surgery for weight loss in adults. Cochrane Database Syst Rev 2014; DOI: 10.1002/14651858.CD003641.pub4.
  • 7 Barola S, Agnihotri A, Khashab MA. et al. Perigastric fluid collection after endoscopic sleeve gastroplasty. Endoscopy 2016; 48: E340-E341
  • 8 Lopez-Nava G, Galvão MP, Bautista-Castaño I. et al. Endoscopic sleeve gastroplasty: How I do it?. Obes Surg 2015; 25: 1534-1538
  • 9 Barola S, Kalloo A, Khashab MA. et al. Technical aspects of endoscopic sleeve gastroplasty. VideoGIE 2017; 2: 48
  • 10 Feldman LS, Cao J, Andalib A. et al. A method to characterize the learning curve for performance of a fundamental laparoscopic simulator task: defining “learning plateau” and “learning rate”. Surgery 2009; 146: 381-386
  • 11 Cotton PB, Eisen GM, Aabakken L. et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 2010; 71: 446-454