Learning curve for endoscopic resection of gastric gastrointestinal stromal tumors: a single-center experience.

BackgroundEndoscopic resection (ER) is widely used in the treatment of gastric gastrointestinal stromal tumors (gGISTs). However, no studies have previously described the learning curve (LC) for ER of gGISTs. We aimed to evaluate the LC based on multifarious operative outcomes. MethodsWe included 100 consecutive patients who underwent ER of gGISTs by a single endoscopist from January 2017 to December 2022. Patients were analyzed in groups of 10 to minimize demographic differences and operative time (OT), conversion rate, introperative and postoperative complication were assessed to evaluate the LC. Meanwhile, for the OT, the LC was further analyzed using cumulative sum (CUSUM) method and patients were organized chronologically in three phases. ResultsStatistical decrease in OT, conversion to laparoscopic operation, and postoperative complication after 30 cases (median 80.0 min vs 56.0 min, P < 0.001; 10.0% vs 0%, P = 0.025; 33.3% vs 10.0%, P = 0.004), rate of introperative complication after 20 cases (15.0% vs 1.3%, P = 0.025). CUSUM chart demonstrated that OT increased dramatically before about 30 cases (phase 1) and decreased after 60 cases (phase 3), with a plateau phase in the middle 30 cases (phase 2). Among three phases, the R0 resection and conversion rate were not significantly different. However, OT, introperative and postoperative complications were gradually decreased (P < 0.05). Conclusions: The LC of ER of gGISTs is approximately 60 cases. However, about 30 cases were sufficient to acquire skills in reducing complications and conversion rate during ER procedure.