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Tyberg A, Mishra A, Cheung M, et al. Learning curve for EUS-guided biliary drainage: What have we learned?. Endosc Ultrasound. 2020;9(6):392-396doi: 10.4103/eus.eus_42_20.
Tyberg, A., Mishra, A., Cheung, M., Kedia, P., Gaidhane, M., Craig, C., Tarnasky, P. R., Ardengh, J. C., & Kahaleh, M. (2020). Learning curve for EUS-guided biliary drainage: What have we learned?. Endoscopic ultrasound, 9(6), 392-396. https://doi.org/10.4103/eus.eus_42_20
Tyberg, Amy, et al. "Learning curve for EUS-guided biliary drainage: What have we learned?." Endoscopic ultrasound vol. 9,6 (2020): 392-396. doi: https://doi.org/10.4103/eus.eus_42_20
Tyberg A, Mishra A, Cheung M, Kedia P, Gaidhane M, Craig C, Tarnasky PR, Ardengh JC, Kahaleh M. Learning curve for EUS-guided biliary drainage: What have we learned?. Endosc Ultrasound. 2020 Nov-Dec;9(6):392-396. doi: 10.4103/eus.eus_42_20. PMID: 32687074; PMCID: PMC7811715.
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Endosc Ultrasound. 2020 Nov-Dec;9(6):392-396. doi: 10.4103/eus.eus_42_20.

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

Endoscopic ultrasound

Amy Tyberg, Avantika Mishra, Maggie Cheung, Prashant Kedia, Monica Gaidhane, Cassandra Craig, Paul R Tarnasky, Jose Celso Ardengh, Michel Kahaleh

Affiliations

  1. Division of Gastroenterology, Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ, USA.
  2. Methodist Dallas Medical Center, Dallas, TX, USA.
  3. Hospital das Clinicas da FMRPUSP, Sao Paulo, Brazil.

PMID: 32687074 PMCID: PMC7811715 DOI: 10.4103/eus.eus_42_20

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

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.

Keywords: CUSUM; ERCP; EUS-guided; EUS-guided biliary drainage; biliary drainage; biliary stricture; learning curve

Conflict of interest statement

None

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