BACKGROUND AND AIMS: There are limited data on learning curves and competence in ERCP. By using a standardized data collection tool, we aimed to prospectively define learning curves and measure competence among advanced endoscopy trainees (AETs) by using cumulative sum (CUSUM) analysis. METHODS: AETs were evaluated by attending endoscopists starting with the 26th hands-on ERCP examination and then every ERCP examination during the 12-month training period. A standardized ERCP competency assessment tool (using a 4-point scoring system) was used to grade the examination. CUSUM analysis was applied to produce learning curves for individual technical and cognitive components of ERCP performance (success defined as a score of 1, acceptable and unacceptable failures [p1] of 10% and 20%, respectively). Sensitivity analyses varying p1 and by using a less-stringent definition of success were performed. RESULTS: Five AETs were included with a total of 1049 graded ERCPs (mean ± SD, 209.8 ± 91.6/AET). The majority of cases were performed for a biliary indication (80%). The overall and native papilla allowed cannulation times were 3.1 ± 3.6 and 5.7 ± 4, respectively. Overall learning curves demonstrated substantial variability for individual technical and cognitive endpoints. Although nearly all AETs achieved competence in overall cannulation, none achieved competence for cannulation in cases with a native papilla. Sensitivity analyses increased the proportion of AETs who achieved competence. CONCLUSION: This study demonstrates that there is substantial variability in ERCP learning curves among AETs. A specific case volume does not ensure competence, especially for native papilla cannulation.
BACKGROUND AND AIMS: There are limited data on learning curves and competence in ERCP. By using a standardized data collection tool, we aimed to prospectively define learning curves and measure competence among advanced endoscopy trainees (AETs) by using cumulative sum (CUSUM) analysis. METHODS:AETs were evaluated by attending endoscopists starting with the 26th hands-on ERCP examination and then every ERCP examination during the 12-month training period. A standardized ERCP competency assessment tool (using a 4-point scoring system) was used to grade the examination. CUSUM analysis was applied to produce learning curves for individual technical and cognitive components of ERCP performance (success defined as a score of 1, acceptable and unacceptable failures [p1] of 10% and 20%, respectively). Sensitivity analyses varying p1 and by using a less-stringent definition of success were performed. RESULTS: Five AETs were included with a total of 1049 graded ERCPs (mean ± SD, 209.8 ± 91.6/AET). The majority of cases were performed for a biliary indication (80%). The overall and native papilla allowed cannulation times were 3.1 ± 3.6 and 5.7 ± 4, respectively. Overall learning curves demonstrated substantial variability for individual technical and cognitive endpoints. Although nearly all AETs achieved competence in overall cannulation, none achieved competence for cannulation in cases with a native papilla. Sensitivity analyses increased the proportion of AETs who achieved competence. CONCLUSION: This study demonstrates that there is substantial variability in ERCP learning curves among AETs. A specific case volume does not ensure competence, especially for native papilla cannulation.
Authors: Sunil G Sheth; Darwin L Conwell; David C Whitcomb; Matthew Alsante; Michelle A Anderson; Jamie Barkin; Randall Brand; Gregory A Cote; Steven D Freedman; Andres Gelrud; Fred Gorelick; Linda S Lee; Katherine Morgan; Stephen Pandol; Vikesh K Singh; Dhiraj Yadav; C Mel Wilcox; Phil A Hart Journal: Pancreatology Date: 2017-02-28 Impact factor: 3.996
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Authors: Sachin Wani; Rajesh Keswani; Matt Hall; Samuel Han; Meer Akbar Ali; Brian Brauer; Linda Carlin; Amitabh Chak; Dan Collins; Gregory A Cote; David L Diehl; Christopher J DiMaio; Andrew Dries; Ihab El-Hajj; Swan Ellert; Kimberley Fairley; Ashley Faulx; Larissa Fujii-Lau; Srinivas Gaddam; Seng-Ian Gan; Jonathan P Gaspar; Chitiki Gautamy; Stuart Gordon; Cynthia Harris; Sarah Hyder; Ross Jones; Stephen Kim; Srinadh Komanduri; Ryan Law; Linda Lee; Rawad Mounzer; Daniel Mullady; V Raman Muthusamy; Mojtaba Olyaee; Patrick Pfau; Shreyas Saligram; Cyrus Piraka; Amit Rastogi; Laura Rosenkranz; Fadi Rzouq; Aditi Saxena; Raj J Shah; Violette C Simon; Aaron Small; Jayaprakash Sreenarasimhaiah; Andrew Walker; Andrew Y Wang; Rabindra R Watson; Robert H Wilson; Patrick Yachimski; Dennis Yang; Steven Edmundowicz; Dayna S Early Journal: Clin Gastroenterol Hepatol Date: 2017-06-16 Impact factor: 11.382
Authors: Rena Yadlapati; Rajesh N Keswani; Jody D Ciolino; David P Grande; Zoe I Listernick; Dustin A Carlson; Donald O Castell; Kerry B Dunbar; Andrew J Gawron; C Prakash Gyawali; Philip O Katz; David Katzka; Brian E Lacy; Stuart J Spechler; Roger Tatum; Marcelo F Vela; John E Pandolfino Journal: Clin Gastroenterol Hepatol Date: 2016-07-27 Impact factor: 11.382
Authors: Sung Yong Han; Dong Uk Kim; Moon Won Lee; Young Joo Park; Dong Hoon Baek; Gwang Ha Kim; Geun Am Song Journal: World J Clin Cases Date: 2020-01-06 Impact factor: 1.337