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

Sarina Pasricha, Cary Cotton, Kelly E. Hathorn, Nan Li, William J. Bulsiewicz, W. Asher Wolf, V. Raman Muthusamy, Srinadh Komanduri, Herbert C. Wolfsen, Ronald Pruitt, Atilla Ertan, Gary W. Chmielewski, Nicholas J. Shaheen

    Research output: Contribution to journalArticle

    18 Citations (Scopus)

    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.

    Original languageEnglish (US)
    Article number59846
    Pages (from-to)890-896.e2
    JournalGastroenterology
    Volume149
    Issue number4
    DOIs
    StatePublished - Oct 1 2015

    Fingerprint

    Learning Curve
    Barrett Esophagus
    Metaplasia
    Safety
    Registries
    Therapeutics
    Linear Models
    Pathologic Constriction
    Hospitalization
    Logistic Models
    Research Personnel
    Hemorrhage
    Efficiency

    All Science Journal Classification (ASJC) codes

    • Hepatology
    • Gastroenterology

    Cite this

    Pasricha, S., Cotton, C., Hathorn, K. E., Li, N., Bulsiewicz, W. J., Wolf, W. A., ... Shaheen, N. J. (2015). Effects of the Learning Curve on Efficacy of Radiofrequency Ablation for Barrett's Esophagus. Gastroenterology, 149(4), 890-896.e2. [59846]. https://doi.org/10.1053/j.gastro.2015.06.012

    Effects of the Learning Curve on Efficacy of Radiofrequency Ablation for Barrett's Esophagus. / Pasricha, Sarina; Cotton, Cary; Hathorn, Kelly E.; Li, Nan; Bulsiewicz, William J.; Wolf, W. Asher; Muthusamy, V. Raman; Komanduri, Srinadh; Wolfsen, Herbert C.; Pruitt, Ronald; Ertan, Atilla; Chmielewski, Gary W.; Shaheen, Nicholas J.

    In: Gastroenterology, Vol. 149, No. 4, 59846, 01.10.2015, p. 890-896.e2.

    Research output: Contribution to journalArticle

    Pasricha, S, Cotton, C, Hathorn, KE, Li, N, Bulsiewicz, WJ, Wolf, WA, Muthusamy, VR, Komanduri, S, Wolfsen, HC, Pruitt, R, Ertan, A, Chmielewski, GW & Shaheen, NJ 2015, 'Effects of the Learning Curve on Efficacy of Radiofrequency Ablation for Barrett's Esophagus', Gastroenterology, vol. 149, no. 4, 59846, pp. 890-896.e2. https://doi.org/10.1053/j.gastro.2015.06.012
    Pasricha S, Cotton C, Hathorn KE, Li N, Bulsiewicz WJ, Wolf WA et al. Effects of the Learning Curve on Efficacy of Radiofrequency Ablation for Barrett's Esophagus. Gastroenterology. 2015 Oct 1;149(4):890-896.e2. 59846. https://doi.org/10.1053/j.gastro.2015.06.012
    Pasricha, Sarina ; Cotton, Cary ; Hathorn, Kelly E. ; Li, Nan ; Bulsiewicz, William J. ; Wolf, W. Asher ; Muthusamy, V. Raman ; Komanduri, Srinadh ; Wolfsen, Herbert C. ; Pruitt, Ronald ; Ertan, Atilla ; Chmielewski, Gary W. ; Shaheen, Nicholas J. / Effects of the Learning Curve on Efficacy of Radiofrequency Ablation for Barrett's Esophagus. In: Gastroenterology. 2015 ; Vol. 149, No. 4. pp. 890-896.e2.
    @article{79f0fb3fcce944948413a1c5e1841b0d,
    title = "Effects of the Learning Curve on Efficacy of Radiofrequency Ablation for Barrett's Esophagus",
    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.",
    author = "Sarina Pasricha and Cary Cotton and Hathorn, {Kelly E.} and Nan Li and Bulsiewicz, {William J.} and Wolf, {W. Asher} and Muthusamy, {V. Raman} and Srinadh Komanduri and Wolfsen, {Herbert C.} and Ronald Pruitt and Atilla Ertan and Chmielewski, {Gary W.} and Shaheen, {Nicholas J.}",
    year = "2015",
    month = "10",
    day = "1",
    doi = "10.1053/j.gastro.2015.06.012",
    language = "English (US)",
    volume = "149",
    pages = "890--896.e2",
    journal = "Gastroenterology",
    issn = "0016-5085",
    publisher = "W.B. Saunders Ltd",
    number = "4",

    }

    TY - JOUR

    T1 - Effects of the Learning Curve on Efficacy of Radiofrequency Ablation for Barrett's Esophagus

    AU - Pasricha, Sarina

    AU - Cotton, Cary

    AU - Hathorn, Kelly E.

    AU - Li, Nan

    AU - Bulsiewicz, William J.

    AU - Wolf, W. Asher

    AU - Muthusamy, V. Raman

    AU - Komanduri, Srinadh

    AU - Wolfsen, Herbert C.

    AU - Pruitt, Ronald

    AU - Ertan, Atilla

    AU - Chmielewski, Gary W.

    AU - Shaheen, Nicholas J.

    PY - 2015/10/1

    Y1 - 2015/10/1

    N2 - 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.

    AB - 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.

    UR - http://www.scopus.com/inward/record.url?scp=84942362176&partnerID=8YFLogxK

    UR - http://www.scopus.com/inward/citedby.url?scp=84942362176&partnerID=8YFLogxK

    U2 - 10.1053/j.gastro.2015.06.012

    DO - 10.1053/j.gastro.2015.06.012

    M3 - Article

    VL - 149

    SP - 890-896.e2

    JO - Gastroenterology

    JF - Gastroenterology

    SN - 0016-5085

    IS - 4

    M1 - 59846

    ER -