Learning curve for EUS-guided biliary drainage: What have we learned?

Area of Science:

• Gastroenterology
• Interventional Endoscopy
• Surgical Learning Curves

Background:

• Endoscopic retrograde cholangiopancreatography (ERCP) failure necessitates alternative biliary drainage methods.
• Endoscopic ultrasound-guided biliary drainage (EUS-BD) is a viable and safe alternative for patients with failed ERCP.
• EUS-BD is technically demanding, requiring specialized expertise.

Purpose of the Study:

• To define the learning curve for endoscopic ultrasound-guided biliary drainage (EUS-BD).
• To assess the relationship between procedural experience and EUS-BD outcomes.

Main Methods:

• A prospective registry of 72 consecutive patients undergoing EUS-BD by a single operator over 6 years.
• Data collection included demographics, procedural details, adverse events, and follow-up.
• Nonlinear regression and CUSUM analyses were used to evaluate the learning curve.

Main Results:

• Technical success rate was 96% (69/72 patients); clinical success was 86% (59/69 patients).
• Adverse events occurred in 10% of patients (bleeding, liver abscess).
• Median procedural time decreased from 59 minutes at the 32nd case, approaching a plateau after 100 cases.

Conclusions:

• Procedural efficiency in EUS-BD improves with experience, with a learning rate of 32 cases.
• Significant reduction in procedural time is observed with increasing case numbers.
• Mastery of EUS-BD is suggested around 100 cases, indicating a well-defined learning curve.