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Background <p>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.</p> Methods <p>We retrospectively reviewed 168 POEM procedures performed between 2015 and 2021 by three endoscopists, each with experience in &gt; 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).</p> Results <p>Learning curve inflection points occurred at 15–20 cases, after which procedure time decreased significantly (94.9 ± 27.4 vs. 55.5 ± 15.5&#xa0;min, <i>p</i> &lt; 0.001). Complication rates were stable (competence phase: 19.6% vs. proficiency phase: 17.1%, <i>p</i> = 0.70), while hospital stay was shorter in the proficiency phase (7.6 ± 2.5 vs. 6.6 ± 2.0&#xa0;days, <i>p</i> = 0.009). Both phases achieved high 3-year success rates (90% vs. 95%, <i>p</i> = 0.563), consistent with published benchmarks.</p> Conclusions <p>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.</p>

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

  • 期刊论文

  • 发表日期：

    2025年12月5日

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  • Liu Simao,
  • Chang Hongkai,
  • Gu Junnan,
  • Li Wenyan,
  • Li Peng,
  • Yu Li,
  • Niu Yinglin,
  • Meng Fandong

摘要

Background

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.

Methods

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).

Results

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.

Conclusions

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.