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DOI: 10.1055/a-1766-5259
Cumulative sum learning curves guiding multicenter multidisciplinary quality improvement of EUS-guided tissue acquisition of solid pancreatic lesions
Abstract
Background and study aims In this study, we evaluated the performance of community hospitals involved in the Dutch quality in endosonography team regarding yield of endoscopic ultrasound (EUS)-guided tissue acquisition (TA) of solid pancreatic lesions using cumulative sum (CUSUM) learning curves. The aims were to assess trends in quality over time and explore potential benefits of CUSUM as a feedback-tool.
Patients and methods All consecutive EUS-guided TA procedures for solid pancreatic lesions were registered in five community hospitals between 2015 and 2018. CUSUM learning curves were plotted for overall performance and for performance per center. The American Society of Gastrointestinal Endoscopy-defined key performance indicators, rate of adequate sample (RAS), and diagnostic yield of malignancy (DYM) were used for this purpose. Feedback regarding performance was provided on multiple occasions at regional interest group meetings during the study period.
Results A total of 431 EUS-guided TA procedures in 403 patients were included in this study. The overall and per center CUSUM curves for RAS improved over time. CUSUM curves for DYM revealed gradual improvement, reaching the predefined performance target (70 %) overall, and in three of five contributing centers in 2018. Analysis of a sudden downslope development in the CUSUM curve of DYM in one center revealed temporary absence of a senior cytopathologist to have had a temporary negative impact on performance.
Conclusions CUSUM-derived learning curves allow for assessment of best practices by comparison among peers in a multidisciplinary multicenter quality improvement initiative and proved to be a valuable and easy-to-interpret means to evaluate EUS performance over time.
Publikationsverlauf
Eingereicht: 03. September 2021
Angenommen nach Revision: 03. Dezember 2021
Artikel online veröffentlicht:
14. April 2022
© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
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References
- 1 Wani S, Wallace MB, Cohen J. et al. Quality indicators for EUS. Am J Gastroenterol 2015; 110: 102-113
- 2 Kitano M, Yoshida T, Itonaga M. et al. Impact of endoscopic ultrasonography on diagnosis of pancreatic cancer. J Gastroenterol 2019; 54: 19-32
- 3 Tempero MA, Malafa MP, Al-Hawary M. et al. Pancreatic Adenocarcinoma, Version 2.2017, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2017; 15: 1028-1061
- 4 Kaye AD, Okanlawon OJ, Urman RD. Clinical performance feedback and quality improvement opportunities for perioperative physicians. Adv Med Educ Pract 2014; 5: 115-123
- 5 Wani S, Wallace MB, Cohen J. et al. Quality indicators for EUS. Gastrointest Endosc 2015; 81: 67-80
- 6 Eloubeidi MA. Developing an academic EUS program: the University of Alabama at Birmingham experience. Gastrointest Endosc 2007; 65: 1039-1041 ; discussion 1039
- 7 Gordon HM, Lloyd DAJ, Higginson A. et al. A regional EUS service using a collaborative network. Frontline Gastroenterol 2017; 8: 26-28
- 8 Oppong KW, Richardson DL, Charnley RM. et al. The development and evolution of a tertiary pancreaticobiliary endoscopic ultrasound service: lessons learned. Frontline Gastroenterol 2011; 2: 66-70
- 9 Wani S, Keswani RN, Han S. et al. Competence in endoscopic ultrasound and endoscopic retrograde cholangiopancreatography, from training through independent practice. Gastroenterology 2018; 155: 1483-1494 e1487
- 10 Wani S, Cote GA, Keswani R. et al. Learning curves for EUS by using cumulative sum analysis: implications for American Society for Gastrointestinal Endoscopy recommendations for training. Gastrointest Endosc 2013; 77: 558-565
- 11 Lee LS, Andersen DK, Ashida R. et al. EUS and related technologies for the diagnosis and treatment of pancreatic disease: research gaps and opportunities-Summary of a National Institute of Diabetes and Digestive and Kidney Diseases workshop. Gastrointest Endosc 2017; 86: 768-778
- 12 Wani S, Hall M, Keswani RN. et al. Variation in aptitude of trainees in endoscopic ultrasonography, based on cumulative sum analysis. Clin Gastroenterol Hepatol 2015; 13: 1318-1325 e1312
- 13 Wani S, Hall M, Wang AY. et al. Variation in learning curves and competence for ERCP among advanced endoscopy trainees by using cumulative sum analysis. Gastrointest Endosc 2016; 83: 711-719 e711
- 14 Quispel R, van Driel L, Honkoop P. et al. Collaboration of community hospital endosonographers improves diagnostic yield of endoscopic ultrasonography guided tissue acquisition of solid pancreatic lesions. Endosc Int Open 2019; 7: E800-E807
- 15 Dumonceau JM, Deprez PH, Jenssen C. et al. Indications, results, and clinical impact of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline – Updated January 2017. Endoscopy 2017; 49: 695-714
- 16 Eltoum IA, Chhieng DC, Jhala D. et al. Cumulative sum procedure in evaluation of EUS-guided FNA cytology: the learning curve and diagnostic performance beyond sensitivity and specificity. Cytopathology 2007; 18: 143-150
- 17 Williams SM, Parry BR, Schlup MM. Quality control: an application of the cusum. BMJ 1992; 304: 1359-1361
- 18 Davies OL. Design and analysis of industrial experiments: Statistica Neerlandica. Malden, USA: Wiley-Blackwell Publishing; 1955
- 19 [Anonymous]. JAGS 4.3.0. In: Source Forge.
- 20 Erler NS, Rizopoulos D, Lesaffre EMEH. JointAI: Joint Analysis and imputation of incomplete data in R. In: Center EUM ed. ArXiv.org arXiv:1907.10867. California, USA: Foundation for Open Access Statistics; 2020
- 21 Hewitt MJ, McPhail MJ, Possamai L. et al. EUS-guided FNA for diagnosis of solid pancreatic neoplasms: a meta-analysis. Gastrointest Endosc 2012; 75: 319-331
- 22 Vanbiervliet G, Napoleon B, Saint Paul MC. et al. Core needle versus standard needle for endoscopic ultrasound-guided biopsy of solid pancreatic masses: a randomized crossover study. Endoscopy 2014; 46: 1063-1070
- 23 Tarantino I, Di Mitri R, Fabbri C. et al. Is diagnostic accuracy of fine needle aspiration on solid pancreatic lesions aspiration-related? A multicentre randomised trial. . Dig Liver Dis 2014; 46: 523-526
- 24 Laquiere A, Lefort C, Maire F. et al. 19 G nitinol needle versus 22 G needle for transduodenal endoscopic ultrasound-guided sampling of pancreatic solid masses: a randomized study. Endoscopy 2019; 51: 436-443
- 25 Lee JK, Lee KT, Choi ER. et al. A prospective, randomized trial comparing 25-gauge and 22-gauge needles for endoscopic ultrasound-guided fine needle aspiration of pancreatic masses. Scand J Gastroenterol 2013; 48: 752-757
- 26 Noh DH, Choi K, Gu S. et al. Comparison of 22-gauge standard fine needle versus core biopsy needle for endoscopic ultrasound-guided sampling of suspected pancreatic cancer: a randomized crossover trial. Scand J Gastroenterol 2018; 53: 94-99
- 27 Bang JY, Hebert-Magee S, Trevino J. et al. Randomized trial comparing the 22-gauge aspiration and 22-gauge biopsy needles for EUS-guided sampling of solid pancreatic mass lesions. Gastrointest Endosc 2012; 76: 321-327
- 28 Woo YS, Lee KH, Noh DH. et al. 22G versus 25G biopsy needles for EUS-guided tissue sampling of solid pancreatic masses: a randomized controlled study. Scand J Gastroenterol 2017; 52: 1435-1441
- 29 Crino SF, Le Grazie M, Manfrin E. et al. Randomized trial comparing fork-tip and side-fenestrated needles for EUS-guided fine-needle biopsy of solid pancreatic lesions. Gastrointest Endosc 2020; 92: 648-658 e642
- 30 Capurso G, Archibugi L, Petrone MC. et al. Slow-pull compared to suction technique for EUS-guided sampling of pancreatic solid lesions: a meta-analysis of randomized controlled trials. Endosc Int Open 2020; 8: E636-E643
- 31 Kudo T, Kawakami H, Hayashi T. et al. High and low negative pressure suction techniques in EUS-guided fine-needle tissue acquisition by using 25-gauge needles: a multicenter, prospective, randomized, controlled trial. Gastrointest Endosc 2014; 80: 1030-1037 e1031
- 32 Wani S, Early D, Kunkel J. et al. Diagnostic yield of malignancy during EUS-guided FNA of solid lesions with and without a stylet: a prospective, single blind, randomized, controlled trial. Gastrointest Endosc 2012; 76: 328-335
- 33 Wang Y, Wang RH, Ding Z. et al. Wet- versus dry-suction techniques for endoscopic ultrasound-guided fine-needle aspiration of solid lesions: a multicenter randomized controlled trial. Endoscopy 2020; 52: 995-1003
- 34 Abe Y, Kawakami H, Oba K. et al. Effect of a stylet on a histological specimen in EUS-guided fine-needle tissue acquisition by using 22-gauge needles: a multicenter, prospective, randomized, controlled trial. Gastrointest Endosc 2015; 82: 837-844 e831
- 35 Noyez L. Control charts, Cusum techniques and funnel plots. A review of methods for monitoring performance in healthcare. Interact Cardiovasc Thorac Surg 2009; 9: 494-499
- 36 Kovacevic B, Vilmann P. EUS tissue acquisition: From A to B. Endosc Ultrasound 2020; 9: 225-231
- 37 Hut-Mossel L, Ahaus K, Welker G. et al. Understanding how and why audits work in improving the quality of hospital care: A systematic realist review. PLoS One 2021; 16: e0248677