PMID- 36097829
OWN - NLM
STAT- MEDLINE
DCOM- 20230310
LR  - 20230310
IS  - 1443-1661 (Electronic)
IS  - 0915-5635 (Linking)
VI  - 35
IP  - 3
DP  - 2023 Mar
TI  - Learning curve for peroral endoscopic myotomy in therapeutic endoscopy experts 
      and nonexperts: Large single-center experience.
PG  - 323-331
LID - 10.1111/den.14435 [doi]
AB  - OBJECTIVES: Reports on learning curve for peroral endoscopic myotomy (POEM) in 
      therapeutic endoscopy nonexperts are limited. We aimed to assess the number of 
      cases required to achieve POEM proficiency for endoscopic submucosal dissection 
      (ESD) experts and nonexperts. METHODS: This is a retrospective study at the 
      largest POEM referral center in Japan. POEM between April 2014 and December 2020 
      were included. Nonexperts and ESD experts were divided by training phases: A, 
      1-20; B, 21-40; C, 41-60; D, 61-80; and E, 81-100 cases. Primary outcome was 
      operation time, and the phase to reach target time (83 min) was investigated. 
      Secondary outcomes were clinical success rate, adverse events, and post-POEM 
      gastroesophageal reflux disease (GERD). RESULTS: Five hundred and sixty-six cases 
      were performed by 14 nonexperts, and 555 cases by 15 ESD experts. As the primary 
      outcome, operation time in nonexperts was: A, 95 (79-115.8); B, 86.5 (71-105); C, 
      80 (70-100); D, 73 (64.5-100.5); and E, 73.5 (57.8-88.8) min, while in ESD 
      experts: A, 90 (74-128); B, 77 (70-92); and C, 77 (70-93.5) min (median 
      [interquartile range]). Operation time decreased significantly as experience 
      increased in both groups (P < 0.001), and nonexperts required 41-60 cases to 
      achieve proficiency, while experts required 21-40 cases. As secondary outcomes, 
      in nonexperts, clinical success was 96.9-100%, adverse events were 5.0-9.2%, 
      symptomatic GERD was 11.8-26.5%, and proton pump inhibitor (PPI) intake was 
      11.5-18.7% in each phase. While in experts, clinical success was 96.2-100%, 
      adverse events were 3.0-5.8%, symptomatic GERD was 14.6-22.0%, and PPI intake was 
      12.6-17.9%. There were no significant differences among training phases. 
      CONCLUSIONS: Non-ESD experts require more cases to achieve proficiency in POEM. 
      These results are useful for establishing POEM training programs and 
      institutional implementation of the procedure.
CI  - (c) 2022 Japan Gastroenterological Endoscopy Society.
FAU - Fujiyoshi, Yusuke
AU  - Fujiyoshi Y
AUID- ORCID: 0000-0002-5893-6552
AD  - Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan.
AD  - Division of Gastroenterology, St. Michael's Hospital, University of Toronto, 
      Toronto, Canada.
FAU - Inoue, Haruhiro
AU  - Inoue H
AD  - Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan.
FAU - Fujiyoshi, Mary Raina Angeli
AU  - Fujiyoshi MRA
AUID- ORCID: 0000-0002-5860-9164
AD  - Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan.
AD  - Division of Gastroenterology, St. Michael's Hospital, University of Toronto, 
      Toronto, Canada.
FAU - Rodriguez de Santiago, Enrique
AU  - Rodriguez de Santiago E
AD  - Department of Gastroenterology and Hepatology, Hospital Universitario Ramon y 
      Cajal, Universidad de Alcala, Madrid, Spain.
AD  - Instituto Ramon y Cajal de Investigacion Sanitaria, Madrid, Spain.
FAU - Nishikawa, Yohei
AU  - Nishikawa Y
AD  - Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan.
FAU - Toshimori, Akiko
AU  - Toshimori A
AUID- ORCID: 0000-0003-4773-8769
AD  - Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan.
FAU - Tanabe, Mayo
AU  - Tanabe M
AUID- ORCID: 0000-0001-6126-5684
AD  - Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan.
FAU - Shimamura, Yuto
AU  - Shimamura Y
AUID- ORCID: 0000-0003-4107-9264
AD  - Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan.
FAU - Sumi, Kazuya
AU  - Sumi K
AD  - Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan.
FAU - Ono, Masashi
AU  - Ono M
AD  - Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan.
FAU - Shiwaku, Hironari
AU  - Shiwaku H
AD  - Department of Gastroenterological Surgery, Fukuoka University Faculty of 
      Medicine, Fukuoka, Japan.
FAU - Ikeda, Haruo
AU  - Ikeda H
AD  - Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan.
FAU - Onimaru, Manabu
AU  - Onimaru M
AD  - Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan.
LA  - eng
PT  - Journal Article
DEP - 20221026
PL  - Australia
TA  - Dig Endosc
JT  - Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy 
      Society
JID - 9101419
RN  - 0 (Proton Pump Inhibitors)
SB  - IM
MH  - Humans
MH  - Retrospective Studies
MH  - *Esophageal Achalasia/surgery
MH  - Learning Curve
MH  - Treatment Outcome
MH  - Endoscopy/methods
MH  - *Gastroesophageal Reflux/etiology/surgery
MH  - Proton Pump Inhibitors/therapeutic use
MH  - *Myotomy/methods
MH  - *Natural Orifice Endoscopic Surgery/methods
MH  - Esophageal Sphincter, Lower/surgery
OTO - NOTNLM
OT  - POEM
OT  - achalasia
OT  - education
OT  - learning curve
OT  - peroral endoscopic myotomy
EDAT- 2022/09/14 06:00
MHDA- 2023/03/11 06:00
CRDT- 2022/09/13 04:06
PHST- 2022/06/19 00:00 [received]
PHST- 2022/09/11 00:00 [accepted]
PHST- 2022/09/14 06:00 [pubmed]
PHST- 2023/03/11 06:00 [medline]
PHST- 2022/09/13 04:06 [entrez]
AID - 10.1111/den.14435 [doi]
PST - ppublish
SO  - Dig Endosc. 2023 Mar;35(3):323-331. doi: 10.1111/den.14435. Epub 2022 Oct 26.