Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2015 Oct;149(4):890-6.e2.
doi: 10.1053/j.gastro.2015.06.012. Epub 2015 Jun 25.

Effects of the Learning Curve on Efficacy of Radiofrequency Ablation for Barrett's Esophagus

Sarina Pasricha  1 , Cary Cotton  1 , Kelly E Hathorn  1 , Nan Li  1 , William J Bulsiewicz  1 , W Asher Wolf  1 , V Raman Muthusamy  2 , Srinadh Komanduri  3 , Herbert C Wolfsen  4 , Ron E Pruitt  5 , Atilla Ertan  6 , Gary W Chmielewski  7 , Nicholas J Shaheen  8
Affiliations
Multicenter Study

Effects of the Learning Curve on Efficacy of Radiofrequency Ablation for Barrett's Esophagus

Sarina Pasricha et al. Gastroenterology. 2015 Oct.

Abstract

Background & aims: Complete eradication of Barrett's esophagus (BE) often requires multiple sessions of radiofrequency ablation (RFA). Little is known about the effects of case volume on the safety and efficacy of RFA or about the presence or contour of learning curves for this procedure.

Methods: We collected data from the US RFA Patient Registry (from 148 institutions) for patients who underwent RFA for BE from July 2007 to July 2011. We analyzed the effects of the number of patients treated by individual endoscopists and individual centers on safety and efficacy outcomes of RFA. Outcomes, including stricture, bleeding, hospitalization, and complete eradication of intestinal metaplasia (CEIM), were assessed using logistic regression. The effects of center and investigator experience on numbers of treatment sessions to achieve CEIM were examined using linear regression.

Results: After we controlled for potential confounders, we found that as the experience of endoscopists and centers increased with cases, the numbers of treatment sessions required to achieve CEIM decreased. This relationship persisted after adjusting for patient age, sex, race, length of BE, and presence of pretreatment dysplasia (P < .01). Center experience was not significantly associated with overall rates of CEIM or complete eradication of dysplasia. We did not observe any learning curve with regard to risks of stricture, gastrointestinal bleeding, perforation, or hospitalization (P > .05).

Conclusions: Based on analysis of a large multicenter registry, efficiency of the treatment, as measured by number of sessions needed to achieve CEIM, increased with case volume, indicating a learning curve effect. This trend began to disappear after treatment of approximately 30 patients by the center or individual endoscopist. However, there was no significant association between safety or efficacy outcomes and previous case volume.

Keywords: Cancer Prevention; Database Analysis; Endoscopy; Training.

PubMed Disclaimer

Figures

Figure 1
Figure 1. Suggested follow-up protocol
In the U.S. RFA registry the treatment and surveillance protocols were suggested but not enforced.
Figure 2
Figure 2. Mean Number of Sessions Required to Achieve CEIM by the Center’s Total Case Experience Prior to Patients’ First RFA Treatment
Efficiency reached a steady state after about thirty patients treated with RFA at a given center.
See this image and copyright information in PMC

References

    1. Ronkainen J, Aro P, Storskrubb T, et al. Prevalence of Barrett’s esophagus in the general population: an endoscopic study. Gastroenterology. 2005;129:1825–31. - PubMed
    1. Hvid-Jensen F, Pedersen L, Drewes AM, et al. Incidence of adenocarcinoma among patients with Barrett’s esophagus. N Engl J Med. 2011;365:1375–83. - PubMed
    1. Sharma P. Clinical practice. Barrett’s esophagus. N Engl J Med. 2009;361:2548–56. - PubMed
    1. van Soest EM, Dieleman JP, Siersema PD, et al. Increasing incidence of Barrett’s oesophagus in the general population. Gut. 2005;54:1062–6. - PMC - PubMed
    1. Sikkema M, de Jonge PJ, Steyerberg EW, et al. Risk of esophageal adenocarcinoma and mortality in patients with Barrett’s esophagus: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2010;8:235–44. quiz e32. - PubMed

Publication types

MeSH terms

Supplementary concepts