Multicenter Analysis of the Learning Curve for Endoscopic Ultrasound-Guided Gallbladder Drainage: A Cumulative Sum Approach

초록

Objectives Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is effective and safe for poor surgical candidates; however, it remains technically challenging with potential serious adverse events. This study evaluated the learning curve for EUS-GBD for safe and effective procedures. Methods From January 2016 to January 2024, 146 patients underwent EUS-GBD performed by three endosonographers. We analyzed the baseline characteristics, procedural outcomes, and learning curves using cumulative sum (CUSUM) analysis. Results No significant differences were found among the three operators regarding technical success (96.4% vs. 94% vs. 95.1%; p = 0.85), clinical success (96.4% vs. 92% vs. 95.1%; p = 0.61), mean procedure time (8.0 +/- 5.7 vs. 9.9 +/- 7.9 vs. 9.9 +/- 5.1 min; p = 0.24), or procedural adverse events (12.7% vs. 20% vs. 9.8%; p = 0.35). CUSUM analysis revealed that proficiency in procedure time was achieved after performing 27 procedures. Comparing procedure time before and after achieving technical proficiency, technical success (90.6% vs. 98.8%, p = 0.04), clinical success (89.1% vs. 98.8%, p = 0.02), and procedure time (14.45 +/- 6.13 min vs. 5.09 +/- 2.23 min, p < 0.01) were improved. Adverse event proficiency was reached in 23 procedures, with notable improvements post-proficiency; technical success (87.5% vs. 99%, p = 0.02), clinical success (85.4% vs. 99%, p = 0.01), and procedure time were also improved (15.04 +/- 6.43 min vs. 6.33 +/- 3.99 min, p < 0.01). Conclusions Based on CUSUM analysis, approximately 23 procedures may be required to achieve technical proficiency in EUS-GBD with regard to minimizing adverse events, while 27 procedures are necessary to reach proficiency in terms of procedure time.

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