Comprehensive evaluation of the learning curve for submucosal tunneling endoscopic resection

Area of Science:

• Gastroenterology
• Endoscopic Surgery
• Surgical Education

Background:

• Submucosal tunneling endoscopic resection (STER) is an advanced endoscopic technique for treating submucosal tumors (SMTs).
• Understanding the learning curve is crucial for safe and efficient adoption of new endoscopic procedures.

Purpose of the Study:

• To analyze the learning curve for submucosal tunneling endoscopic resection (STER) in endoscopists with no prior experience.
• To identify the number of cases required to achieve proficiency in STER.

Main Methods:

• Retrospective analysis of 2018-2024 clinical data from patients undergoing STER.
• Three endoscopists with no prior STER experience performed the procedures.
• Cumulative sum (CUSUM) curves analyzed procedure speed, lesion diameter, resection rates, and complications across different phases.

Main Results:

• The learning curve, defined by CUSUM analysis, indicated proficiency was reached around 16-19 cases.
• Procedure speed significantly increased in phase 2 (post-proficiency) compared to phase 1 (P < 0.001).
• Resected lesion diameter also increased significantly for two endoscopists in phase 2 (P < 0.05), with no increase in complications.

Conclusions:

• Approximately 20 cases are needed for endoscopists to gain fundamental proficiency in STER.
• STER demonstrates a feasible learning curve with significant improvements in efficiency and technique over time.
• High en bloc and complete resection rates were maintained throughout the learning process.