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• W3136848877 abstract "We read with interest the article by Jovani et al.1Jovani M, Ichkhanian Y, Parsa N, et al. An assessment of the learning curve for EUS-guided gastroenterostomy for a single operator. Gastrointest Endosc. Epub 2020 Sep 26.Google Scholar The authors concluded that based on the performance of a single operator, proficiency and mastery for EUS-guided gastroenterostomy (EUS-GE) are achieved after 25 and 40 procedures, respectively. Another recently published single-operator study from a different institution reported that 7 EUS-GE cases were adequate to achieve efficiency.2Tyberg A. Kats D. Choi A. et al.Endoscopic ultrasound guided gastroenterostomy: what is the learning curve?.J Clin Gastroenterol. 2020; 8: E92-E96Google Scholar The adverse events from these 2 endoscopists showed discrepancy: 5.6% (4 of 73 cases) in Jovani et al1Jovani M, Ichkhanian Y, Parsa N, et al. An assessment of the learning curve for EUS-guided gastroenterostomy for a single operator. Gastrointest Endosc. Epub 2020 Sep 26.Google Scholar versus 26% (6 of 23 cases) in Tyberg et al.2Tyberg A. Kats D. Choi A. et al.Endoscopic ultrasound guided gastroenterostomy: what is the learning curve?.J Clin Gastroenterol. 2020; 8: E92-E96Google Scholar Although single-operator studies can be informative on the learning curve at an individual level for a particular procedure, its results may not be generalizable. In addition, as gastroenterology becomes increasingly multidisciplinary, there should be caution in applying the concept of a learning curve on individual endoscopists because there are other team members involved in the procedure. The progressive increase in efficiency and decline in adverse events may be reflective of the increased experience among the proceduralists and their support team, including endoscopy nurses, anesthesiologists, and technicians.3Taunk P. Jacobson B.C. EUS instruments, room setup, and assistants.in: Gress F.G. Savides T.J. Endoscopic Ultrasonography. John Wiley, Chichester2016: 27-33Crossref Google Scholar For a broader perspective on the learning curve for EUS at an institution level, another retrospective review of 968 consecutive EUS procedures (864 patients; 54% female; 79% white; mean age, 61 years) performed during the first 5 years (2015-2019) of a new EUS program with 6 endoscopists found that the adverse event rate was inversely correlated with years of experience (P = .02), with the probability of an adverse event decreasing by an average of 22% per year (stratification of the incidence of adverse events by year showed a decline in the incidence of adverse events from 12.7% in 2015 to 4.0% in 2019).4Elfanagely Y. Tse C.S. Monteiro J.F.G. et al.Incidence and risk factors for adverse events after endoscopic ultrasound [abstract].Gastrointest Endosc. 2020; 91: AB299-AB300Abstract Full Text Full Text PDF Google Scholar Overall, mastery of an intervention depends not only on individual attributes but also on the practice environment and the multidisciplinary team members involved. All authors disclosed no financial relationships. Assessment of the learning curve for EUS-guided gastroenterostomy for a single operatorGastrointestinal EndoscopyVol. 93Issue 5PreviewEUS-guided gastroenterostomy (EUS-GE) is increasingly used as an alternative to surgery and enteral stent placement to manage gastric outlet obstruction (GOO). However, no data are available on the learning curve (LC) for EUS-GE. Defining the LC is necessary to create adequate subspecialty training programs and quality assurance. Full-Text PDF ResponseGastrointestinal EndoscopyVol. 93Issue 4PreviewWe thank Elfanagely et al1 for their interest and thoughtful comments regarding our article.2 We agree that other factors, besides operator experience, can and do influence procedural time. Unfortunately, it is very difficult, if not impossible, to capture the “background noise” from outside influences and therefore to isolate specifically the influence of an operator’s expertise on procedural time (although we do believe that the operator’s experience is the major influencer on procedural time). Full-Text PDF" @default.
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• W3136848877 date "2021-04-01" @default.
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• W3136848877 title "Learning curves for EUS: single operators, endoscopy teams, and institutions" @default.
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• W3136848877 doi "https://doi.org/10.1016/j.gie.2020.10.031" @default.
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