{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T10:46:53Z","timestamp":1789469213854,"version":"build-2803163510"},"reference-count":27,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T00:00:00Z","timestamp":1768176000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T00:00:00Z","timestamp":1768176000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Gastro and Hepatol"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Endoscopic ultrasound\u2010guided gallbladder drainage (EUS\u2010GBD) is effective and safe for poor surgical candidates; however, it remains technically challenging with potential serious adverse events. This study evaluated the learning curve for EUS\u2010GBD for safe and effective procedures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>From January 2016 to January 2024, 146 patients underwent EUS\u2010GBD performed by three endosonographers. We analyzed the baseline characteristics, procedural outcomes, and learning curves using cumulative sum (CUSUM) analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      No significant differences were found among the three operators regarding technical success (96.4% vs. 94% vs. 95.1%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.85), clinical success (96.4% vs. 92% vs. 95.1%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.61), mean procedure time (8.0\u2009\u00b1\u20095.7 vs. 9.9\u2009\u00b1\u20097.9 vs. 9.9\u2009\u00b1\u20095.1\u2009min;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.24), or procedural adverse events (12.7% vs. 20% vs. 9.8%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.35). CUSUM analysis revealed that proficiency in procedure time was achieved after performing 27 procedures. Comparing procedure time before and after achieving technical proficiency, technical success (90.6% vs. 98.8%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.04), clinical success (89.1% vs. 98.8%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.02), and procedure time (14.45\u2009\u00b1\u20096.13\u2009min vs. 5.09\u2009\u00b1\u20092.23\u2009min,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01) were improved. Adverse event proficiency was reached in 23 procedures, with notable improvements post\u2010proficiency; technical success (87.5% vs. 99%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.02), clinical success (85.4% vs. 99%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.01), and procedure time were also improved (15.04\u2009\u00b1\u20096.43\u2009min vs. 6.33\u2009\u00b1\u20093.99\u2009min,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Based on CUSUM analysis, approximately 23 procedures may be required to achieve technical proficiency in EUS\u2010GBD with regard to minimizing adverse events, while 27 procedures are necessary to reach proficiency in terms of procedure time.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgh.70239","type":"journal-article","created":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T09:31:59Z","timestamp":1768210319000},"page":"1001-1008","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Multicenter Analysis of the Learning Curve for Endoscopic Ultrasound\u2010Guided Gallbladder Drainage: A Cumulative Sum Approach"],"prefix":"10.1111","volume":"41","author":[{"given":"Dongwook","family":"Oh","sequence":"first","affiliation":[{"name":"Department of Gastroenterology University of Ulsan College of Medicine, Asan Medical Center  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-0135-7042","authenticated-orcid":false,"given":"Ho\u00a0Seung","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Korea University Anam Hospital  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8664-4090","authenticated-orcid":false,"given":"Sung\u00a0Hyun","family":"Cho","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology University of Ulsan College of Medicine, Asan Medical Center  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gunn","family":"Huh","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology University of Ulsan College of Medicine, Asan Medical Center  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dong\u2010Wan","family":"Seo","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology University of Ulsan College of Medicine, Asan Medical Center  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min\u2010Ju","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology and Biostatistics University of Ulsan College of Medicine, Asan Medical Center  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seong\u2010Hun","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Research Institute of Clinical Medicine of Jeonbuk National University\u2010Biomedical Research Institute of Jeonbuk National University Hospital  Jeonju Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tae\u00a0Jun","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology University of Ulsan College of Medicine, Asan Medical Center  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,1,12]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/jhbp.516"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/jhbp.504"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0034-1365720"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2011.03.1120"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2009.11.024"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2015.05.045"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2011.12.051"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1159\/000509215"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2019.09.042"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2015-309925"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1055\/a-1717-1391"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1055\/a-1005-6602"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00534-012-0568-9"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/jhbp.515"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2009.10.027"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2014.08.024"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2013-305973"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1155\/2018\/7070961"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-016-4894-x"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-018-6041-3"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-022-09339-y"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/12.5.433"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2019-319996"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-018-6406-7"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2018.08.052"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1080\/07853890.2023.2282748"},{"key":"e_1_2_8_28_1","first-page":"142","article-title":"Endoscopic 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