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The learning curve for transoral incisionless fundoplication
Mohamad Dbouk1,2, Olaya I Brewer Gutierrez1, Bijun Sai Kannadath3
1Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States.
Endoscopy International Open
|November 18, 2021
Summary
Gastroenterologists can achieve proficiency in transoral incisionless fundoplication (TIF) for GERD after 18-20 procedures. This minimally invasive technique demonstrates a steep learning curve but leads to safe, effective, and efficient patient outcomes.
Area of Science:
- Gastroenterology
- Minimally Invasive Surgery
- Medical Device Technology
Background:
- Gastroesophageal reflux disease (GERD) is a common condition often treated with medication.
- Transoral incisionless fundoplication (TIF) offers a minimally invasive endoscopic alternative for GERD management.
- The learning curve for TIF has not been previously established.
Purpose of the Study:
- To determine the learning curve for transoral incisionless fundoplication (TIF) performed by a single therapeutic endoscopist.
- To identify the number of procedures required to achieve consistent technical proficiency and efficiency in TIF.
- To assess the impact of training on TIF outcomes.
Main Methods:
- Prospective data analysis of 72 TIF procedures performed by one endoscopist over 17 months.
- Cumulative sum of means (CUSUM) analysis to detect learning thresholds.
- Breakpoint analysis to evaluate proficiency and efficiency metrics (plication time, procedure duration).
Main Results:
- Proficiency in TIF valve creation (≥270° circumference, ≥2 cm length) was achieved between the 18th and 20th procedures.
- Maximum efficiency in plication time was reached after the 26th procedure (2.7 minutes).
- Overall TIF procedure time significantly decreased after the 44th procedure (39.4 minutes).
Conclusions:
- Transoral incisionless fundoplication (TIF) is a safe, effective, and efficient endoscopic procedure for GERD.
- A therapeutic endoscopist can achieve TIF proficiency after 18-20 independently performed procedures.
- The TIF learning curve is steep but manageable with dedicated training and experience.
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