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Year : 2020  |  Volume : 9  |  Issue : 3  |  Page : 175-179

EUS-guided pancreatic drainage: A steep learning curve

1 Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
2 Methodist Dallas Medical Center, Dallas, TX, USA
3 UAB Multispecialty Clinic, Montgomery, AL, USA
4 Thomas Jefferson Hospital, Philadelphia, PA, USA
5 Hospital University of Sao Paulo, Sao Paulo, Brazil

Correspondence Address:
Dr. Michel Kahaleh
Robert Wood Johnson University Hospital, 1 RWJ Place, MEB 464, New Brunswick, NJ 08901
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/eus.eus_3_20

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Background and Objective: EUS-guided pancreatic drainage (EUS-PD) is an efficacious, acceptable risk option for patients with pancreatic duct obstruction who fail conventional ERCP. The aim of this study was to define the learning curve (LC) for EUS-PD. Methods: Consecutive patients undergoing EUS-PD by a single operator were included from a dedicated registry. Demographics, procedural info, adverse events, and follow-up data were collected. Nonlinear regression and cumulative sum (CUSUM) analyses were conducted for the LC. Results: Fifty-six patients were included (54% of male, with a mean age of 58 years). Technical success was achieved in 47 patients (84%). Stent placement was antegrade in 36 patients (77%) and retrograde in 11 (23%). Clinical success was achieved in 46/47 (98%) patients who achieved technical success. Adverse events were seen in 13 patients (6 of whom did not achieve technical success) and included bleeding requiring embolization (n = 5), bleeding treated with clips peri-procedurally (n = 1), pancreatitis (n = 5), and a pancreatic fluid collection drained via EUS-drainage (n = 2). The median procedural time was 80 min (range 49–159 min). The CUSUM chart showed that 80-min procedural time was achieved at the 27th procedure. Durations further reduced 40th procedure onward, reaching a plateau indicating proficiency (nonlinear regression P < 0.0001). Conclusion: Endoscopists experienced in EUS-PD are expected to achieve a reduction in procedural time over successive cases, with efficiency reached at 80 min and a learning rate of 27 cases. Continued improvement is demonstrated with additional experience, with plateau indicating mastery suggested at the 40th case. EUS-PD is probably one of the hardest therapeutic endosonographic procedures to learn.

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