SNFGE SNFGE
 
Thématique :
- Endoscopie/Imagerie
- Œsophage/Estomac
Originalité :
Intermédiaire
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Pas encore
 
 
Nom du veilleur :
Professeur Emmanuel CORON
Coup de coeur :
 
 
Gastroenterology
  2015/10  
 
  2015 Oct;149(4):890-896.e2  
  doi: 10.1053/j.gastro.2015.06.012  
 
  Effects of the Learning Curve on Efficacy of Radiofrequency Ablation for Barrett's Esophagus  
 
  Pasricha S, Cotton C, Hathorn KE, Li N, Bulsiewicz WJ, Wolf WA, Muthusamy VR, Komanduri S, Wolfsen HC, Pruitt RE, Ertan A, Chmielewski GW,Shaheen NJ  
  http://www.ncbi.nlm.nih.gov/pubmed/26116806  
 
 

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.

Copyright © 2015 AGA Institute. Published by Elsevier Inc. All rights reserved.

 
Question posée
 
L’expérience de l’opérateur concernant la radiofréquence (RF) œsophagienne joue-t-elle un rôle dans l’efficacité du traitement ou la survenue de complications ?
 
Question posée
 
Les opérateurs (et/ou centres) expérimentés en RF ont un nombre de sessions (donc un coût de traitement) moins élevé que les moins expérimentés pour arriver à une éradication complète de la muqueuse de Barrett. En revanche, leur taux de succès global en termes d’éradication de la muqueuse de Barrett et leur taux de complications (sténoses, saignements, perforations) n’étaient pas différents.
 
Commentaires

Ce travail renforce l’impression générale que la technique de RF est relativement facile à maîtriser, et est finalement bien standardisée. Le problème pour un centre est plutôt d’avoir le recrutement nécessaire pour justifier réellement de l’intérêt à s’équiper.

 
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