Changes in clinical outcomes from EMR before and after change point in RA-CUSUM curve analysis for endoscopist proficiency gain (A) non-cancer patients and (B) patients with oesophagogastric cancer
| Outcome | Change point | Overall rate | Before change point | After change point | p Value |
|---|---|---|---|---|---|
| (A) Non-cancer patients | |||||
| Emergency intervention | No PGC | – | – | – | – |
| 30-day mortality | 2 cases | 1.0% (0.8% to 1.2%) | 1.8% (1.4% to 2.3%) | 0.5% (0.4% to 0.7%) | <0.001 |
| 90-day mortality | 2 cases | 2.2% (2.0% to 2.5%) | 3.6% (3.1% to 4.3%) | 1.3% (1.1% to 1.7%) | <0.001 |
| (B) Patients with oesophagogastric cancer | |||||
| Emergency intervention | 1 case | 0.6% (0.3% to 1.3%) | 1.5% (0.7% to 3.2%) | 0.1% (0.0% to 0.8%) | 0.009 |
| 30-day mortality | 4 cases | 3.1% (2.2% to 4.3%) | 4.5% (3.2% to 6.3%) | 0.3% (0.1% to 1.5%) | <0.001 |
| 90-day mortality | 2 cases | 6.8% (5.4% to 8.4%) | 10.8% (8.4% to 13.6%) | 2.6% (1.5% to 4.3%) | <0.001 |
| Re-intervention | 43 cases | 23.6% (21.1% to 26.2%) | 24.6% (22.0% to 27.3%) | 10.8% (5.4% to 19.4%) | 0.005 |
| Oesophagectomy/gastrectomy | 14.6% (12.9% to 16.8%) | 15.3% (13.2% to 17.6%) | 5.3% (2.1% to 12.8%) | 0.017 | |
| Repeat EMR | 9.0% (7.4% to 10.9%) | 9.3% (7.6% to 11.2%) | 5.3% (2.1% to 12.8%) | 0.238 | |
Emergency intervention was defined as an acute emergency operation or endoscopic stent insertion performed within 14 days of the primary EMR procedure.
Re-intervention was defined as repeat EMR, oesophagectomy or gastrectomy for the treatment of cancer at least 30 days following the initial EMR procedure.
EMR, endoscopic mucosal resection; PGC, proficiency gain curve; RA-CUSUM, risk-adjusted cumulative sum.