EUS-guided pancreatic drainage: A steep learning curve.

Area of Science:

• Gastroenterology
• Endosonography
• Interventional Endoscopy

Background:

• Endoscopic retrograde cholangiopancreatography (ERCP) failure in pancreatic duct obstruction necessitates alternative treatments.
• EUS-guided pancreatic drainage (EUS-PD) offers an effective, albeit risk-acceptable, therapeutic option.

Purpose of the Study:

• To define the learning curve (LC) for EUS-guided pancreatic drainage (EUS-PD).
• To establish benchmarks for procedural proficiency and mastery in EUS-PD.

Main Methods:

• A single-operator, consecutive patient series undergoing EUS-PD was analyzed.
• Data collected included demographics, procedural details, adverse events, and follow-up.
• Nonlinear regression and cumulative sum (CUSUM) analyses were employed to assess the learning curve.

Main Results:

• Technical success was achieved in 84% of 56 patients, with clinical success in 98% of those with technical success.
• Adverse events occurred in 13 patients, including bleeding and pancreatitis.
• Procedural time, a key learning curve metric, reduced significantly, with proficiency indicated around the 27th case and plateauing by the 40th case.

Conclusions:

• The learning curve for EUS-PD suggests efficiency is reached around 80 minutes, with a learning rate of approximately 27 cases.
• Mastery, indicated by a plateau in procedural time, is suggested around the 40th case.
• EUS-PD represents a challenging therapeutic procedure within endosonography, requiring significant experience for proficiency.