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Updated: Mar 20, 2026
06:42
Use of the Scissor-Type Knife During the Peroral Endoscopy Myotomy Procedure for the Treatment of Achalasia
Published on: March 3, 2023
3.7K
Learning curve for peroral endoscopic myotomy.
Mohamad El Zein1, Vivek Kumbhari1, Saowanee Ngamruengphong1
1Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
Endoscopy International Open
|May 27, 2016
Summary
The learning curve for peroral endoscopic myotomy (POEM) suggests that proficiency is reached after approximately 13 cases. This indicates a significant decrease in procedure time with increasing experience for gastroenterologists performing POEM.
Area of Science:
- Gastroenterology
- Interventional Endoscopy
- Surgical Education
Background:
- Peroral endoscopic myotomy (POEM) is increasingly utilized for esophageal motility disorders.
- The learning curve for POEM among gastroenterologists requires further investigation.
Purpose of the Study:
- To define the learning curve for POEM procedures.
- To identify factors influencing POEM procedure and step completion times.
Main Methods:
- Retrospective analysis of 60 consecutive POEM procedures performed by a single expert.
- POEM procedure divided into four steps: mucosal entry, submucosal tunneling, myotomy, and closure.
- Nonlinear regression used to determine learning plateau and rate.
Main Results:
- Total operative time significantly decreased with experience (P < 0.001), reaching a plateau around 13 cases.
- Mucosal entry, tunneling, and closure times improved significantly with experience.
- Myotomy time did not show a significant decrease with experience (P = 0.35).
Conclusions:
- A minimum of approximately 13 cases is suggested for an expert interventional endoscopist to reach a plateau in POEM performance.
- Increased case volume is significantly associated with reduced procedure length.
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