Imperial College London
Alternate

MrJeremyHuddy

Faculty of Medicine, Department of Surgery & Cancer

Honorary Clinical Senior Lecturer
 
 
 
//

Contact

 

j.huddy

 
 
//

Location

 

Queen Elizabeth the Queen Mother Wing (QEQM)St Mary's Campus

//

Summary

 

Publications

Citation

BibTex format

@article{Markar:2017:10.1136/gutjnl-2015-311237,
author = {Markar, S and Mackenzie, H and Ni, Z and Huddy, J and Askari, A and Faiz, O and Griffin, M and Lovat, L and Hanna, GB},
doi = {10.1136/gutjnl-2015-311237},
journal = {Gut},
pages = {79--85},
title = {The influence of procedural volume and proficiency gain on mortality from upper GI endoscopic mucosal resection},
url = {http://dx.doi.org/10.1136/gutjnl-2015-311237},
volume = {67},
year = {2017}
}
Download

RIS format (EndNote, RefMan)

TY  - JOUR
AB  - ObjectiveEndoscopic mucosal resection (EMR) is established for the management of benign and early malignant upper gastrointestinal disease. The aim of this observational study was to establish the effect of endoscopist procedural volume on mortality.DesignPatients undergoing upper gastrointestinal EMR between 1997 and 2012 were identified from the Hospital Episode Statistics database. The primary outcome was 30-day mortality and secondary outcomes were 90-day mortality, requirement for emergency intervention and elective cancer reintervention. Risk-adjusted Cumulative Sum (RA-CUSUM) analysis was used to assess patient mortality-risk during initial stage of endoscopist proficiency gain and the effect of endoscopist and hospital volume. Mortality was compared before and after the change point or threshold in RA-CUSUM curve.Results11,051 patients underwent upper gastrointestinal EMR. Endoscopist procedure volume was an independent predictor of 30-day mortality. Fifty-eight percent of EMR procedures were performed by endoscopists with annual volume of 2 cases or less, and had a higher 30- and 90-day mortality rate for cancer patients, 6.1% vs. 0.4%; P<0.001 and 12% vs. 2.1%; P<0.001 respectively. The requirement for emergency intervention after EMR for cancer was also greater with low-volume endoscopists (1.8%vs. 0.1%; P=0.002). In cancer patients, the RA-CUSUM curve change-point for 30-day mortality and elective re-intervention was 4 and 43 cases respectively.ConclusionEMR performed by high volume endoscopists is associated with reduced adverse outcomes. In order to reach proficiency, appropriate training and procedural volume accreditation training programmes are needed nationally.
AU  - Markar,S
AU  - Mackenzie,H
AU  - Ni,Z
AU  - Huddy,J
AU  - Askari,A
AU  - Faiz,O
AU  - Griffin,M
AU  - Lovat,L
AU  - Hanna,GB
DO  - 10.1136/gutjnl-2015-311237
EP  - 85
PY  - 2017///
SN  - 1468-3288
SP  - 79
TI  - The influence of procedural volume and proficiency gain on mortality from upper GI endoscopic mucosal resection
T2  - Gut
UR  - http://dx.doi.org/10.1136/gutjnl-2015-311237
UR  - http://hdl.handle.net/10044/1/39555
VL  - 67
ER  -
Download