Endoscopic sleeve gastroplasty: the learning curve

Area of Science:

• Bariatric Endoscopy
• Minimally Invasive Surgery
• Gastroenterology

Background:

• Endoscopic sleeve gastroplasty (ESG) is an emerging minimally invasive bariatric procedure.
• A potential barrier to ESG adoption is the perceived slow learning curve, even for endoscopists skilled in endoscopic suturing.
• This study defines the learning curve for ESG in an experienced endoscopist.

Purpose of the Study:

• To determine the learning curve for endoscopic sleeve gastroplasty (ESG).
• To assess the impact of experience on procedure length and number of plications.
• To establish the number of cases required to reach a plateau in ESG proficiency.

Main Methods:

• A single endoscopist with prior endoscopic suturing experience underwent a 1-day ESG training.
• Twenty-one consecutive ESG procedures performed between February and November 2016 were analyzed.
• Nonlinear regression was used to calculate the learning rate and plateau for length of procedure (LOP) and number of plications.

Main Results:

• LOP significantly decreased across consecutive procedures, plateauing at approximately 101.5 minutes after 7 cases.
• The number of plications per procedure also significantly decreased, reaching a plateau at 8 sutures after 9 cases.
• The average time per plication demonstrated a significant decrease, plateauing at 9 procedures.

Conclusions:

• Endoscopists experienced in endoscopic suturing can achieve proficiency in ESG relatively quickly.
• The learning curve for ESG is characterized by significant improvements in efficiency within the first 7-9 cases.
• These findings suggest that ESG can be implemented effectively by experienced endoscopists with a defined training pathway.