Learning curve for peroral endoscopic myotomy in therapeutic endoscopy experts and nonexperts: Large single-center experience.

Autor: Fujiyoshi Y; Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan.; Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Canada., Inoue H; Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan., Fujiyoshi MRA; Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan.; Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Canada., Rodriguez de Santiago E; Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain.; Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain., Nishikawa Y; Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan., Toshimori A; Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan., Tanabe M; Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan., Shimamura Y; Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan., Sumi K; Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan., Ono M; Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan., Shiwaku H; Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan., Ikeda H; Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan., Onimaru M; Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan.
Jazyk: angličtina
Zdroj: Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society [Dig Endosc] 2023 Mar; Vol. 35 (3), pp. 323-331. Date of Electronic Publication: 2022 Oct 26.
DOI: 10.1111/den.14435
Abstrakt: 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.
(© 2022 Japan Gastroenterological Endoscopy Society.)
Databáze: MEDLINE
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