Learning curves and the influence of procedural volume for the treatment of dysplastic Barrett's esophagus.,Gastrointestinal Endoscopy

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Learning curves and the influence of procedural volume for the treatment of dysplastic Barrett's esophagus.
Gastrointestinal Endoscopy ( IF 7.7 ) Pub Date : 2020-03-05 , DOI: 10.1016/j.gie.2020.02.041
Gideon Lipman ₁ , Sheraz Markar ₂ , Abhinav Gupta ₃ , , Rehan J Haidry ₄ , Laurence B Lovat ₄

Affiliation

Background and Aims

Endoscopic resections and radiofrequency ablation (RFA) are the established treatments for Barrett’s-associated dysplasia and early esophageal neoplasia. The UK RFA Registry collects patient outcomes from 24 centers treating patients in the United Kingdom and Ireland. Learning curves for treatment of Barrett’s dysplasia and the impact of center caseload on patient outcomes is still unknown.

Methods

We examined outcomes of 678 patients treated with RFA in the UK Registry using risk-adjusted cumulative sum control chart (RA-CUSUM) analysis to identify change points in complete resolution of intestinal metaplasia (CR-IM) and complete resolution of dysplasia (CR-D) outcomes. We compared outcomes between those treated at high-volume (>100 enrolled patients), medium-volume (51-100), and low-volume (<50) centers.

Results

There was no association between center volume and CR-IM and CR-D rates, but recurrence rates were lower in high-volume versus low-volume centers (log rank P = .001). There was a significant change point for outcomes at 12 cases for CR-D (reduction from 24.5% to 10.4%; P < .001) and at 18 cases for CR-IM (30.7% to 18.6%; P < .001) from RA-CUSUM curve analysis.

Conclusion

Our data suggest that 18 supervised cases of endoscopic ablation may be required before competency in endoscopic treatment of Barrett’s dysplasia can be achieved. The difference in outcomes between a high-volume and low-volume center does not support further centralization of services to only high-volume centers.

中文翻译：

学习曲线和程序量对增生性Barrett食管治疗的影响。

背景和目标

内窥镜切除术和射频消融术（RFA）是巴雷特相关的不典型增生和早期食管瘤形成的治疗方法。英国RFA注册中心从英国和爱尔兰的24个治疗患者的中心收集患者结果。尚不清楚用于治疗Barrett发育异常的学习曲线以及中心病例数对患者预后的影响。

方法

我们使用风险调整后的累积总和控制图（RA-CUSUM）分析在英国注册中心检查了678例接受RFA治疗的患者的结局，以鉴定肠化生完全消退（CR-IM）和异型增生（CR- D）结果。我们比较了在高容量（> 100名入组患者），中容量（51-100）和低容量（<50）中心接受治疗的结果。

结果

中心容量与CR-IM和CR-D率之间没有关联，但是高容量中心与低容量中心的复发率较低（log rank P = .001）。从12例CR-D（从24.5％降低到10.4％; P <.001）和18例CR-IM（30.7％到18.6％; P <.001）的结局都有显着变化。 RA-CUSUM曲线分析。