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News

Learning curve to achieve satisfactory completion rates in upper GI endoscopy

The latest issue of Gut analyzes a national training database to examine the learning curve to achieve satisfactory completion rates in upper GI endoscopy.

News image

Dr Dunckley and colleagues determined the number of esophago-gastro-duodenoscopies trainees need to perform to acquire competency in terms of successful unassisted completion to the second part of the duodenum 95% of the time.

Esophago-gastro-duodenoscopies data were retrieved from the trainee e-portfolio developed by the Joint Advisory Group on GI Endoscopy (JAG) in the UK. 

All trainees were included unless they were known to have a baseline experience of more than 20 procedures or had submitted data for less than 20 procedures. 

The researchers' primary outcome measure was esophago-gastro-duodenoscopies completion, defined as passage of the endoscope to the second part of the duodenum without physical assistance. 

The number of esophago-gastro-duodenoscopies required to achieve a 95% completion rate was calculated by the moving average method and learning curve cumulative summation (LC-Cusum) analysis. 

By moving average method, trainees attained a 95% completion rate at 187 procedures
Gut
The team determined which factors were independently associated with esophago-gastro-duodenoscopies completion, a mixed effects logistic regression model was constructed with esophago-gastro-duodenoscopies completion as the outcome variable.

Data were analyzed for 1255 trainees over 288 centers, representing 243,555 esophago-gastro-duodenoscopies. 

By moving average method, trainees attained a 95% completion rate at 187 procedures. 

By learning curve cumulative summation analysis, after 200 procedures, more than 90% trainees had attained a 95% completion rate. 

Total number of esophago-gastro-duodenoscopies performed, trainee age and experience in lower GI endoscopy were factors independently associated with esophago-gastro-duodenoscopy completion.

Dr Dunckley's team comments, "There are limited published data on the esophago-gastro-duodenoscopies learning curve."

"This is the largest study to date analyzing the learning curve for competency acquisition."

"The JAG competency requirement for 200 procedures appears appropriate."

Gut 2017;66:1022-1033
17 May 2017

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