The learning progression of diagnostic sialendoscopy

To evaluate the learning progression of a single surgeon to implement and perform diagnostic sialendoscopy: to estimate how many procedures were necessary to achieve better results; if it was higher rate of complications in the beginning.

METHODS:

Retrospective analysis involving 113 consecutive sialendoscopies performed from 2010 to 2013. According to a descriptive analysis of the factors related to surgeon's experience, the casuistic was divided into two groups: group (A) comprising the first 50 exams, and group (B) the last 63. Groups were then compared concerning demographic and peri-operative aspects.

RESULTS:

In Group A, failure to catheterize papilla were 22% versus 3% in B (p = 0.001). Failure to complete examination was 30% in group A versus 6% in B (p = 0.001), and necessity to repeat exams was 22% in group A versus 10% in B (p = 0.058). The complication rates were 18% in group A, and 10% in B (p = 0.149). Operative time was slightly shorter in group B (56 versus 41 min, p = 0.045).

CONCLUSION:

We found better outcomes after the first 50 diagnostic sialendoscopies. Complication rates were statistically the same between early and late groups of experience with sialendoscopy.

Keywords:
Salivary gland diseases; Endoscopy; Diagnosis

	Early group – A (n = 50)	Late group – B (n = 63)	Total
Salivary stone^a	13 (26%)	10 (16%)	23 (20%)
Other obstructive sialadenitis^a	26 (52%)	22 (35%)	48 (43%)
Radioiodine induced sialadenitis^a	2 (4%)	13 (21%)	15 (13%)
Sjogren syndrome	5 (10%)	6 (9%)	11 (10%)
Recurrent juvenile parotitis^a	1 (2%)	6 (9%)	7 (6%)
Acute sialadenitis	2 (4%)	4 (7%)	6 (5%)
Obstruction after open-surgery	1 (2%)	2 (3%)	3 (3%)

	Early group – A (n = 50)	Late group – B (n = 63)	Total	p
Failure of diagnostic sialendoscopy	15 (30%)	4 (6%)	19 (17%)	0.001^a
Failure of papilla catheterization	11 (22%)	2 (3%)
Failure to complete examination	4 (8%)	2 (3%)
Necessity to repeat sialendoscopy	11 (22%)	6 (10%)	17 (15%)	0.058
Perioperative complication	9 (18%)	6 (10%)	15 (13%)	0.149

	Early group – A (n = 35)	Late group – B (n = 59)	Total
Lithiasic disease	12 (34%)	11 (19%)	23 (25%)
Ductal stenosis	11 (31%)	20 (34%)	31 (33%)
Chronic sialadenitis signs	3 (9%)	12 (20%)	15 (16%)
Acute sialadenitis signs	2 (6%)	4 (7%)	6 (6%)
Only ductal plugs of mucus	2 (6%)	9 (15%)	11 (12%)
Normal aspects	5 (14%)	3 (5%)	8 (8%)

Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Sede da Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico Facial, Av. Indianópolia, 1287, 04063-002 São Paulo/SP Brasil, Tel.: (0xx11) 5053-7500, Fax: (0xx11) 5053-7512 - São Paulo - SP - Brazil
E-mail: revista@aborlccf.org.br

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[1] * Corresponding author. E-mail:higinosteck@gmail.com (J.H. Steck).