The learning curve for needle knife precut sphincterotomy revisited

Area of Science:

• Gastroenterology
• Endoscopic Procedures
• Medical Training

Background:

• Lack of consensus on adequate training for needle knife precut sphincterotomy.
• Need to establish objective criteria for procedural competency.

Purpose of the Study:

• Determine the minimum number of procedures for effective and safe precut sphincterotomy.
• Analyze success and complication rates based on cumulative experience.

Main Methods:

• Retrospective analysis of a single endoscopist's experience (2006-2015).
• Evaluation of precut sphincterotomy success (>85%) and complication (<10%) rates.
• Statistical analysis using a one-sided binomial test for procedural milestones.

Main Results:

• Sustained success rate above 85% achieved after 13 precut sphincterotomies.
• Significantly higher success rate (91.2%) observed by the 125th procedure.
• Complication rates for bleeding (1.3%) and pancreatitis (3.2%) remained below 5% after 50 procedures; no perforations occurred.

Conclusions:

• A minimum of 13 precut sphincterotomies are necessary for a sustained success rate exceeding 85%.
• Procedural safety, with complication rates below 5%, is established after 50 precut sphincterotomies.