Learning curve for EUS in gastric cancer T staging by using cumulative sum analysis

Chan Hyuk Park, Jun Chul Park, Eun Hye Kim, Da Hyun Jung, Hyunsoo Chung, Sung Kwan Shin, Sang Kil Lee, Yong Chan Lee

Research output: Contribution to journalArticlepeer-review

15 Citations (Scopus)


Background EUS is an operator-dependent procedure and requires more technical and cognitive skills than a routine endoscopic procedure. The learning curve for the staging of gastric cancer, however, has not been evaluated. Objective To evaluate the threshold number of EUS examinations for gastric cancer T staging. Design Retrospective study. Setting University-affiliated tertiary care hospital in the Republic of Korea. Patients Four trainees with no previous EUS experience. Intervention Analyzing performance of EUS trainees in gastric cancer T staging by using cumulative sum (CUSUM) analysis. Main Outcome Measurements CUSUM plot and a minimal number of procedures for reaching a plateau. Results A total of 553 initial EUS examinations for treatment-naïve gastric cancers, performed by trainees, were enrolled in the study. The final T stage was determined by experts by using EUS in 332 gastric cancer cases, whereas the T stage of the other 221 lesions was determined by trainees by using EUS. The accuracy of EUS examinations performed by trainees and experts was 72.6% and 84.3%, respectively. The number of EUS examinations required to reach the first plateau in each trainee was 20, 41, 60, and 65. Limitations Retrospective study with a relatively small number of trainees. Conclusion The CUSUM scores of all of 4 trainees in the study reached a plateau by the 65th examination.

Original languageEnglish
Pages (from-to)898-905.e1
JournalGastrointestinal endoscopy
Issue number4
Publication statusPublished - 2015 Apr 1

Bibliographical note

Publisher Copyright:
© 2015 American Society for Gastrointestinal Endoscopy.

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology


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