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Poster Session E - Tuesday Afternoon

E0434 - Learning Curve of Transoral Incisionless Fundoplication: A Proficiency Study

Tuesday, October 25, 2022

3:00 PM – 5:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Robert L. Pecha, MD

Baylor College of Medicine
Houston, TX

Robert L. Pecha, MD, Tara Keihanian, MD, Margarita Riojas Barrett, , Kalpesh K. Patel, MD
Baylor College of Medicine, Houston, TX

Introduction: Transoral incisionless fundoplication (TIF) is a minimally invasive endoscopic procedure for treatment of gastroesophageal reflux disease. Performing TIF requires unique training to achieve proficiency. This study aims to evaluate the learning curve of performing TIF in relation to patient and procedure-specific characteristics.

Methods: This is a retrospective study of consecutive TIF procedures performed by a single experienced gastroenterologist to assess the procedure learning curve. Historical and procedural characteristics were recorded, and the learning curve was estimated by cumulative sum of means (CUSUM) analysis. Proficiency was defined as reliably achieving a procedure length less than 45 minutes.

Results: 77 consecutive TIF procedures (68 patients) were included. The average age of patients was 52.35 ± 15.74 years (32.4% male). The estimated learning plateaus for procedure time and number of fasteners were 41 minutes and 24 fasteners, respectively. Twelve procedures were required to reliably achieve a procedure length of 45 minutes or less. There was no significant correlation between the length of the TIF procedure and number of fasteners (p=0.091) or Hill classification (I vs II/III) (p=0.483). There was no relationship between the Hill classification (I vs. II/III) and number of fasteners (p=0.475). We observed a significant increase in average number of fasteners used over time from 18.5 ± 2.28 during the first quartile of procedures to 29.82 ± 4.61 in the last quartile (p=0.01). There was no relationship between procedure length, ASA score, number of fasteners, and hospital length of stay.

Discussion: Proficiency in performing TIF in less than 45 minutes can be achieved after independently performing 12 procedures.

Figure: Non-linear regression curves for proficiency of procedure duration and number of fasteners

Patient summary characteristics:

Gender (Female)

Age [mean ± SD]

Race

White

Non-Hispanic

BMI [mean ± SD]

ASA Score

III

Prior history of Barrett’s ablation

Prior esophageal surgical intervention

Nissen Fundoplication

POEM- Nissen Fundoplication

POEM

Indication for TIF

GERD

Chronic cough +/- GERD

Hernia HILL grade (if available):

Longitudinal length of hernia ≥ 2cm (available value; n=56)

PH impedance or Bravo test (uninterpretable; n=1, not performed due to presence of BE/esophagitis=5)

Acid

Non-acid

67.6% (n=46)

52.35 ± 15.74

79.41% (n=54)

67.65% (n=46)

27.7 ± 5.1

69.1% (n=47)

29.4% (n=20)

1.5% (n=1)

4.4% (n=3)

8.8% (n=6)

1.5% (n=1)

2.9% (n=2)

83.82% (n=57)

16.17% (n=11)

25% (n=14)

62.5% (n=35)

8.9% (n=5)

3.6% (n=1)

26.78% (n=15)

82.26% (n=51)

17.74% (n=11)

Procedure characteristics:

Total TIF procedures

Median procedure length(minutes) [min, max]

Number of fasteners [mean ± SD]

Number of fasteners original TIF per Quartiles [mean ± SD]

First

Second

Third

Forth

Median Hospital LOS (days) [min, max]

(n=77)

41 [26,91]

23.1 ± 6.2

18.5 ± 2.28

21.53 ± 3.12

24.71 ± 3.53

29.82 ± 4.61

1 [0,10]

Table: Baseline patient characteristics and procedural outcomes

Disclosures:

Robert Pecha indicated no relevant financial relationships.

Tara Keihanian indicated no relevant financial relationships.

Margarita Riojas Barrett indicated no relevant financial relationships.

Kalpesh Patel: Boston Scientific – Consultant.

Robert L. Pecha, MD, Tara Keihanian, MD, Margarita Riojas Barrett, , Kalpesh K. Patel, MD. E0434 - Learning Curve of Transoral Incisionless Fundoplication: A Proficiency Study, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.