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Learning curves and the influence of procedural volume for the treatment of dysplastic Barrett's esophagus

Lipman, G; Markar, S; Gupta, A; Haidry, RJ; Lovat, LB; (2020) Learning curves and the influence of procedural volume for the treatment of dysplastic Barrett's esophagus. Gastrointestinal Endoscopy , 92 (3) 543-550.e1. 10.1016/j.gie.2020.02.041. Green open access

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Abstract

BACKGROUND AND AIMS: Endoscopic resections (ER) 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 in the United Kingdom and Ireland treating patients. 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 CUSUM plots 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- (>100 enrolled patients), medium- (51-100) and low- (<50) volume centers. RESULTS: There was no association between center volume and CR-IM and CR-D rates, but there were lower recurrence rates in high-volume versus low-volume centers (Log Rank p=0.001).There was a significant change-point for outcomes at 12 cases for CR-D (reduction from 24.5% to 10.4%; P<0.001) and at 18 cases for CR-IM (30.7% to 18.6%; P<0.001) 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.

Type: Article
Title: Learning curves and the influence of procedural volume for the treatment of dysplastic Barrett's esophagus
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.gie.2020.02.041
Publisher version: https://doi.org/10.1016/j.gie.2020.02.041
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci > Department of Targeted Intervention
URI: https://discovery.ucl.ac.uk/id/eprint/10093499
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