Related Experiment Video
Updated: May 16, 2026
Use of the Scissor-Type Knife During the Peroral Endoscopy Myotomy Procedure for the Treatment of Achalasia
Published on: March 3, 2023
Retrospective cohort study of launching a new peroral pyloromyotomy practice-A framework for introducing endoscopic
Seung Hyeon Shim1, Kevin El-Hayek2, Jennifer Colvin3
1Case Western Reserve University School of Medicine, Cleveland, OH.
Background:
Endoscopic peroral pyloromyotomy for medically refractory gastroparesis requires advanced endoscopic skill. This study describes a learning framework using combined in-person and video-based proctoring.
Methods:
Retrospective data were collected for consecutive patients who underwent peroral pyloromyotomy by a single surgeon trained through a structured program: 4 case observations, 4 animal models, 9 in-person proctoring, and 8 video-based proctoring. Patient demographics, Gastroparesis Cardinal Symptom Index score, gastric emptying scintigraphy, and procedural details were collected. Data were analyzed using a 2-tailed, unpaired t test with unequal variance to compare the safety and effectiveness of video-based to the traditional, in-person proctoring. Short-term clinical outcomes, Gastroparesis Cardinal Symptom Index, and gastric emptying scintigraphy were measured.
Results:
Peroral pyloromyotomy was performed on 17 patients (12 female; mean age, 53.8 years). Etiologies included diabetic (n = 6, 35.3%), idiopathic (n = 9, 52.9%), and postsurgical (n = 2, 11.8%). The median procedure time was 42.7 minutes (mean, 45.3 minutes; range, 29-65 minutes). Throughout both proctoring methods, the surgeon demonstrated safe, effective performance without complications or reintervention. There were no significant differences between in-person proctoring and video-based proctoring in total operative duration (P > .227). Patients exhibited expected clinical improvements with a Gastroparesis Cardinal Symptom Index score reduction of 2.38 units (70.6% reduction, P < .001).
Conclusion:
Through the integration of a novel learning framework, this study showed minimal time and outcome differences between in-person and video-based proctoring. Steps requiring cognitive training unique to endoscopic surgery (mucosotomy and tunneling) and standard myotomy had no statistical difference. This study supports an integrated in-person and video-proctoring framework as a safe and effective method to introduce advanced endoscopic surgery.
