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Learning curve for EUS in gastric cancer T staging by using cumulative sum analysis
Chan Hyuk Park1, Jun Chul Park1, Eun Hye Kim1
1Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea.
Background:
EUS is an operator-dependent procedure and requires more technical and cognitive skills than a routine endoscopic procedure. The learning curve for the staging of gastric cancer, however, has not been evaluated.
Objective:
To evaluate the threshold number of EUS examinations for gastric cancer T staging.
Design:
Retrospective study.
Setting:
University-affiliated tertiary care hospital in the Republic of Korea.
Patients:
Four trainees with no previous EUS experience.
Intervention:
Analyzing performance of EUS trainees in gastric cancer T staging by using cumulative sum (CUSUM) analysis.
Main Outcome Measurements:
CUSUM plot and a minimal number of procedures for reaching a plateau.
Results:
A total of 553 initial EUS examinations for treatment-naïve gastric cancers, performed by trainees, were enrolled in the study. The final T stage was determined by experts by using EUS in 332 gastric cancer cases, whereas the T stage of the other 221 lesions was determined by trainees by using EUS. The accuracy of EUS examinations performed by trainees and experts was 72.6% and 84.3%, respectively. The number of EUS examinations required to reach the first plateau in each trainee was 20, 41, 60, and 65.
Limitations:
Retrospective study with a relatively small number of trainees.
Conclusion:
The CUSUM scores of all of 4 trainees in the study reached a plateau by the 65th examination.
