title: The learning curve for interpretation of oesophageal high-resolution manometry: a prospective interventional cohort study.
abstract: High-resolution manometry has become the preferred choice of oesophagologists for oesophageal motor assessment, but the learning curve among trainees remains unclear.
  
  
  
  To determine the learning curve of high-resolution manometry interpretation.
  
  
  
  A prospective interventional cohort study was performed on 18 gastroenterology trainees, naïve to high-resolution manometry (median age 32 ± 4.0 years, 44.4% female). An intake questionnaire and a 1-h standardised didactic session were performed at baseline. Multiple 1-h interpretation sessions were then conducted periodically over 15 months where 10 studies were discussed; 5 additional test studies were provided for interpretation, and results were compared to gold standard interpretation by the senior author. Hypothetical management decisions based on trainee interpretation were separately queried. Accuracy was compared across test interpretations and sessions to determine the learning curve, with a goal of 90% accuracy.
  
  
  
  Baseline accuracy was low for abnormal body motor patterns (53.3%), but higher for achalasia/outflow obstruction (65.9%). Recognition of achalasia reached 90% accuracy after six sessions (P = 0.01), while overall accurate management decisions reached this threshold by the 4th session (P < 0.001). Based on our data, the threshold of 90% accuracy for recognition of any abnormal from normal pattern was reached after 30 studies (3rd session) but fluctuated. Diagnosis of oesophageal body motor patterns remained suboptimal; accuracy of advisability of fundoplication improved, but did not reach 90%.
  
  
  
  High-resolution manometry has a steep learning curve among trainees. Achalasia recognition is achieved early, but diagnosis of other abnormal motor patterns and management decisions require further supervised training.
authors.affiliation: Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: S
authors.initials: S
authors.lastname: Gaddam
authors.affiliation: Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: C A
authors.initials: CA
authors.lastname: Reddy
authors.affiliation: Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: S
authors.initials: S
authors.lastname: Munigala
authors.affiliation: Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: A
authors.identifier: 0000-0001-7214-5901
authors.initials: A
authors.lastname: Patel
authors.affiliation: Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: N
authors.initials: N
authors.lastname: Kanuri
authors.affiliation: Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: S
authors.initials: S
authors.lastname: Almaskeen
authors.affiliation: Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: M K
authors.initials: MK
authors.lastname: Rude
authors.affiliation: Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: A
authors.initials: A
authors.lastname: Abdalla
authors.affiliation: Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: C P
authors.initials: CP
authors.lastname: Gyawali
mesh_terms: D000328:Adult; D004931:Esophageal Achalasia / Q000175:diagnosis* / Q000503:physiopathology; D004947:Esophagus / Q000503:physiopathology* / Q000601:surgery; D005260:Female; D018662:Fundoplication; D005762:Gastroenterology / Q000193:education* / Q000379:methods; D006801:Humans; D059032:Learning Curve; D008297:Male; D008365:Manometry / Q000379:methods; D011795:Surveys and Questionnaires