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Analysis of the learning curve for peroral endoscopic myotomy for esophageal achalasia: Single‐center, two‐operator experience
Author(s) -
Lv Houning,
Zhao Ningning,
Zheng Zhongqing,
Wang Tao,
Yang Fang,
Jiang Xihui,
Lin Lin,
Sun Chao,
Wang Bangmao
Publication year - 2017
Publication title -
digestive endoscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.5
H-Index - 56
eISSN - 1443-1661
pISSN - 0915-5635
DOI - 10.1111/den.12763
Subject(s) - cusum , medicine , achalasia , myotomy , learning curve , perioperative , esophageal sphincter , esophagus , surgery , general surgery , statistics , mathematics , management , economics , disease , reflux
Background and Aim Peroral endoscopic myotomy ( POEM ) has emerged as an advanced technique for the treatment of achalasia, and defining the learning curve is mandatory. Methods From August 2011 to June 2014, two operators in our institution (A&B) carried out POEM on 35 and 33 consecutive patients, respectively. Moving average and cumulative sum ( CUSUM ) methods were used to analyze the POEM learning curve for corrected operative time ( cOT ), referring to duration of per centimeter myotomy. Additionally, perioperative outcomes were compared among distinct learning curve phases. Results Using the moving average method, cOT reached a plateau at the 29th case and at the 24th case for operators A and B, respectively. CUSUM analysis identified three phases: initial learning period (Phase 1), efficiency period (Phase 2) and mastery period (Phase 3). The relatively smooth state in the CUSUM graph occurred at the 26th case and at the 24th case for operators A and B, respectively. Mean cOT of distinct phases for operator A were 8.32, 5.20 and 3.97 min, whereas they were 5.99, 3.06 and 3.75 min for operator B, respectively. Eckardt score and lower esophageal sphincter pressure significantly decreased during the 1‐year follow‐up period. Data were comparable regarding patient characteristics and perioperative outcomes. Conclusion This single‐center study demonstrated that expert endoscopists with experience in esophageal endoscopic submucosal dissection reached a plateau in learning of POEM after approximately 25 cases.