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Outcomes and quality of life assessment after per oral endoscopic myotomy (POEM) performed in the endoscopy unit with trainees

Surgical Endoscopy volume 32, pages 3046–3054 (2018)Cite this article

Abstract

Background

Per oral endoscopic myotomy (POEM) has emerged as a promising option for the treatment of achalasia. This study assessed POEM training process, outcomes, and improvement in quality of life after POEM performed by an interventional endoscopist (mentor) with trainees.

Methods

We performed a retrospective review of data for patients who underwent POEM with involvement of trainees. Trainees were trained in performing mucosotomy, submucosal dissection, creating submucosal tunnel, identifying gastroesophageal junction, myotomy, and closure of mucosal incision in a step-by-step fashion. Trainees’ performance on each step was evaluated by the mentor based on several key points in each step. The short form 36 (SF36) was obtained before and certain times after the primary POEM procedure was performed.

Results

Sixty-two patients, 26 males and 36 females with a mean age of 59 years, who underwent POEM were enrolled. A checklist included all related items for each step was established. All trainees obtained competence within 6 cases for each step. 61/62 (98.3%) patients had a significant improvement in the Eckardt’s score post POEM: 9.3 ± 1.5 prior to POEM and 2.6 ± 1.2 after the POEM (P = 0.001) and a decrease in mean lower esophageal sphincter pressure (LES): pre- and post-procedure mean LES pressures were 28.5 ± 11.4 and 12.1 ± 4.5 mmHg, respectively (P = 0.001). The SF-36 questionnaire demonstrated a significant improvement in quality of life and comparable with those without trainees in other studies.

Conclusion

This preliminary study showed for the first time that training for POEM can be performed in a step-by-step fashion, learning mucosal incision, submucosal dissection, myotomy, and mucosal incision closure from an expert interventional endoscopist without increasing adverse events. The checklist for each step could be used as an important guide in training POEM. The outcomes of POEM in this study were similar to those reported by others without trainees. Further multiple center studies are needed to verify this training process and to establish a formal training protocol.

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Affiliations

  1. Division of Digestive Diseases, Department of Internal Medicine, Emory University School of Medicine, 1365 Clifton Road, B1262, Atlanta, GA, 30322, USA

    Sunil Dacha, George Philips, Steven A. Keilin, Field F. Willingham & Qiang Cai

  2. Department of Gastroenterology, Nanjing Drum Tower Hospital, Nanjing, Jiangsu, China

    Lei Wang

  3. Department of Gastroenterology, The Affiliated Hospital Qingdao University, Qingdao, Shandong, China

    Xaioyu Li & Yueping Jiang

Authors
  1. Sunil Dacha
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  2. Lei Wang
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  3. Xaioyu Li
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  4. Yueping Jiang
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  5. George Philips
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  6. Steven A. Keilin
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  7. Field F. Willingham
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  8. Qiang Cai
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Contributions

SD: obtaining IRB approval, collection and interpretation of data, drafting and revision of the article; LW: conception and revision of the article; GP: collection of data and revision of the article; XL, YJ, SAK, FFW: revision of the article; QC: Performing all procedures, obtaining IRB approval, conception and the design of the study, revision of the article.

Corresponding author

Correspondence to Qiang Cai.

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Disclosures

Sunil Dacha, Lei Wang, Xaioyu Li, Yueping Jiang, George Philips, Steven A Keilin, Field F Willingham, Qiang Cai have no conflicts of interest or financial ties to disclose.

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Dacha, S., Wang, L., Li, X. et al. Outcomes and quality of life assessment after per oral endoscopic myotomy (POEM) performed in the endoscopy unit with trainees. Surg Endosc 32, 3046–3054 (2018). https://doi.org/10.1007/s00464-017-6015-x

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  • DOI: https://doi.org/10.1007/s00464-017-6015-x

Keywords

  • POEM
  • Achalasia
  • Dysphagia
  • Quality of life assessment