RT Journal Article SR Electronic T1 The influence of procedural volume and proficiency gain on mortality from upper GI endoscopic mucosal resection JF Gut JO Gut FD BMJ Publishing Group Ltd and British Society of Gastroenterology SP 79 OP 85 DO 10.1136/gutjnl-2015-311237 VO 67 IS 1 A1 Sheraz R Markar A1 Hugh Mackenzie A1 Melody Ni A1 Jeremy R Huddy A1 Alan Askari A1 Omar Faiz A1 S Michael Griffin A1 Laurence Lovat A1 George B Hanna YR 2018 UL http://gut.bmj.com/content/67/1/79.abstract AB Objective Endoscopic mucosal resection (EMR) is established for the management of benign and early malignant upper GI disease. The aim of this observational study was to establish the effect of endoscopist procedural volume on mortality.Design Patients undergoing upper GI 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 re-intervention. 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 the RA-CUSUM curve.Results 11 051 patients underwent upper GI EMR. Endoscopist procedure volume was an independent predictor of 30-day mortality. Fifty-eight per cent of EMR procedures were performed by endoscopists with annual volume of 2 cases or less, and had a higher 30-day and 90-day mortality rate for patients with cancer, 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 patients with cancer, the RA-CUSUM curve change points for 30-day mortality and elective re-intervention were 4 cases and 43 cases, respectively.Conclusions EMR 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.