Clin Endosc.  2021 Sep;54(5):701-705. 10.5946/ce.2020.290.

The Learning Curve for Peroral Endoscopic Myotomy in Latin America: A Slide to the Right?

Affiliations
  • 1Robert Wood Johnson University Hospital, New Brunswick, NJ, USA
  • 2Weill Cornell Medical College, New York, NY, USA
  • 3La Policia, Bogota, Colombia
  • 4Borland-Groover, Jacksonville, FL, USA
  • 5Juarez Hospital, Mexico City, Mexico
  • 6Belo Horizonte Hospital, Belo Horizonte, Brazil
  • 7Hospital Escuela Dr. Ramon Madariaga, Posadas, Argentina
  • 8Gemelli University Hospital, Roma, Italy
  • 9Santander Hospital, Reynosa, Mexico
  • 10San Ignacio University Hospital, Bogota, Columbia
  • 11Gastromedica Clinic, Managua, Nicaragua
  • 12Gastrointestinal Endoscopy Unit, University of Sao Paulo, Sao Paulo, Brazil
  • 13Instituto Ecuatoriano de Enfermedades Digestivas, Guayaquil, Ecuador

Abstract

Background/Aims
Per oral endoscopic myotomy (POEM) has been increasingly used for achalasia in Latin America, where Chagas disease is prevalent, and this makes POEM more challenging. The aim of this study was to determine the learning curve for POEM in Latin America.
Methods
Patients undergoing POEM in Latin America with a single operator were included from a prospective registry over 4 years. Non-linear regression and cumulative sum control chart (CUSUM) analyses were conducted for the learning curve.
Results
A total of 125 patients were included (52% male; mean age, 59 years), of which 80 had type II achalasia (64%), and 38 had Chagas disease (30%). The average pre-procedure and post-procedure Eckardt scores were 6.79 and 1.87, respectively. Technical success was achieved in 93.5% of patients, and clinical success was achieved in 88.8%. Adverse events occurred in 27 patients (22%) and included bleeding (4 patients), pneumothorax (4 patients), mucosal perforation (13 patients), mediastinitis (2 patients), and leakage (4 patients).
The CUSUM chart showed a median procedure time of 97 min (range, 45-196 min), which was achieved at the 61st procedure. Procedure duration progressively decreased, with the last 10 procedures under 50 min approaching a plateau (p-value <0.01).
Conclusions
Mastering POEM in Latin America requires approximately 61 procedures for both POEM efficiency and to accomplish the procedure within 97 minutes.

Keyword

Per oral endoscopic myotomy; Achalasia; Chagas; Latin America; Learning Curve

Figure

  • Fig. 1. Cumulative sum control chart shows procedure efficiency duration.

  • Fig. 2. Inverse curve regression showing procedure time decrease significantly over the course of consecutive procedures.


Cited by  1 articles

Issues to be Considered for Learning Curve for Peroral Endoscopic Myotomy
Hironari Shiwaku, Haruhiro Inoue
Clin Endosc. 2021;54(5):625-626.    doi: 10.5946/ce.2021.217.


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