The learning curve for peroral endoscopic myotomy in a tertiary center of China

Achalasia is a rare esophageal motility disorder marked by impaired lower esophageal sphincter relaxation. Peroral endoscopic myotomy (POEM) has become a first-line therapy owing to its minimally invasive approach and proven efficacy. This study aimed to define the POEM learning curve for experienced endoscopists at a tertiary Chinese medical center.

We retrospectively reviewed 168 POEM procedures performed between 2015 and 2021 by three endoscopists, each with experience in > 100 endoscopic submucosal dissections (ESD) cases and trainings on three animal-model. Cumulative sum (CUSUM) analysis of procedure time was the primary measure. Secondary outcomes included complications, length of hospital stay, and 3-year clinical success rate (Eckardt score ≤ 3).

Learning curve inflection points occurred at 15-20 cases, after which procedure time decreased significantly (94.9 ± 27.4 vs. 55.5 ± 15.5 min, p < 0.001). Complication rates were stable (competence phase: 19.6% vs. proficiency phase: 17.1%, p = 0.70), while hospital stay was shorter in the proficiency phase (7.6 ± 2.5 vs. 6.6 ± 2.0 days, p = 0.009). Both phases achieved high 3-year success rates (90% vs. 95%, p = 0.563), consistent with published benchmarks.

For endoscopists with prior ESD expertise, POEM proficiency can be achieved after 15-20 cases, with safety and efficacy maintained throughout training. Shorter hospital stays in the proficiency phase likely reflect improvements in perioperative management.