When is POEM truly equivalent to LHM? A comparison of complication rates during the learning curve

Wong, Wei Jin and Nik Muhamad Affendi, Nik Arsyad and Liau, Siow Yen and Mahendran, Hans Alexander and Peng Choong, Lau and Ho, Shiaw Hooi and Mahadeva, Sanjiv (2023) When is POEM truly equivalent to LHM? A comparison of complication rates during the learning curve. Surgical Endoscopy, 37. pp. 1735-1741. ISSN 0930-2794 E-ISSN 1432-2218

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Abstract

Introduction: Per-Oral Endoscopic Myotomy (POEM) is an effective treatment for Esophageal Achalasia Cardia (EAC) but the endoscopic technique required is complex. As competency is crucial for patient safety, we believe that its' competency can be demonstrated when the complication rate equals that of an established procedure such as Laparoscopic Heller's Myotomy with Fundoplication (LHM + F). Methods: A multicentre, ambi-directional, non-randomized comparison of intra-procedural complications during the learning curve of POEM was performed against a historical cohort of LHM + F. Demographic, clinicopathological, procedural data and complications were collected. A direct head-to-head comparison was performed, followed by a population pyramid of complication frequency. Case sequence was then divided into blocks of 5, and the complication rates during each block was compared to the historical cohort. Results: From January 2010 to April 2021, 60 patients underwent LHM + F and 63 underwent POEM. Mean age was lower for the POEM group (41.7 years vs 48.1 years, p = 0.03), but there was no difference in gender nor type of Achalasia. The POEM group recorded a shorter overall procedural time (125.9 min vs 144.1 min, p = 0.023) and longer myotomies (10.1 cm vs 6.2 cm, p = 0.023). The overall complication rate of POEM was 20.6%, whereas the historical cohort of LHM + F had a rate of 10.0%. On visual inspection of the population pyramid, complications were more frequent in the earlier procedures. On block sequencing, complication frequency could be seen tapering off dramatically after the 25th case, and subsequently equalled that of LHM + F. Conclusion: POEM is challenging even for experienced endoscopists. From our data, complication rates between POEM and LHM + F equalize after approximately 25 POEMs.

Item Type:	Article (Journal)
Uncontrolled Keywords:	3rd-space endoscopy; Heller’s-Dor myotomy; POEM; Surgical education.
Subjects:	R Medicine > R Medicine (General)
Kulliyyahs/Centres/Divisions/Institutes (Can select more than one option. Press CONTROL button):	Kulliyyah of Medicine > Department of Internal Medicine
Depositing User:	Dr Nik Arsyad Nik Muhamad Affendi
Date Deposited:	18 Dec 2023 16:48
Last Modified:	23 Feb 2024 09:15
URI:	http://irep.iium.edu.my/id/eprint/108724

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