Harewood G, Wright C, Baron T. Assessment of the Learning Curve for Endoscopic Pancreatic Fluid Collection Drainage. Gastrointestinal Endoscopy 2003; 57(5)


Abstract

Much attention has been focused in the gastroenterology literature on competence in endoscopic procedures. We sought to determine the impact of procedural experience on patient outcomes following endoscopic pancreatic fluid collection (PFC) drainage. Methods: Retrospective analysis of outcomes in consecutive patients with symptomatic PFCs referred for endoscopic transmural and/or transpapillary drainage was performed. Collections were classified as acute pseudocysts, chronic pseudocysts, and pancreatic necrosis. Outcomes of the first 20 patients were compared with subsequent patients for each PFC type to determine the impact of procedural experience. Results: In total, 175 patients underwent endoscopic PFC drainage; 40 (23%) with acute pseudocyst, 78 (44%) with chronic pseudocyst, and 57 (33%) with pancreatic necrosis. First 20 and subsequent patients were similar with respect to age, gender, and PFC size for each PFC type. Chronic pseudocyst resolution rates improved considerably following the first 20 procedures with a reduction in days to resolution, 50 days (initial 20 procedures) to 33.5 days (subsequent procedures), p = 0.05 (see Table). In patients with pancreatic necrosis, median hospital stay shortened with procedural experience, 23 days to I S days, p = 0.01 (see Table): There was no obvious improvement in patient outcomes with procedural experience for acute pseudocysts (see Table). Conclusions: Procedural experience enhances chronic pseudocyst resolution following endoscopic drainage. Overall procedure complication rates, PFC recurrence rates, and patient outcomes following acute pseudocyst drainage appear to be independent of procedural experience.