Successful Design and Implementation of a POEM Program for Achalasia in an Integrated Healthcare System.
Achalasia
Competency
Implementation
Integrated healthcare system
Peroral endoscopic myotomy
Journal
Digestive diseases and sciences
ISSN: 1573-2568
Titre abrégé: Dig Dis Sci
Pays: United States
ID NLM: 7902782
Informations de publication
Date de publication:
06 2023
06 2023
Historique:
received:
13
09
2022
accepted:
15
01
2023
medline:
18
5
2023
pubmed:
2
2
2023
entrez:
1
2
2023
Statut:
ppublish
Résumé
Per Oral Endoscopic Myotomy (POEM) is a minimally invasive treatment for achalasia with results comparable to laparoscopic Heller myotomy (LHM). Studies have described the development of proficiency for endoscopists learning to perform POEM, and societies have defined educational and technical objectives for advanced endoscopy fellows in training. However, there is limited guidance on the organizational strategy and educational plan necessary to develop an achalasia service with POEM expertise. We aim to outline the steps for design and implementation of a successful POEM program. We reported our experience developing a multi-disciplinary clinical program for POEM and the steps taken to achieve procedural proficiency. We also reported our technical success (successful tunneling into the gastric cardia and myotomy of LES muscle fibers) and clinical success (post-procedure Eckardt score ≤ 3) at 3-6 months and 12 months post-procedure. Adverse events were classified per the ASGE lexicon for endoscopic adverse events. After creating a multi-disciplinary clinical program for achalasia and completing procedural proficiency for POEM, our technical success rate was 100% and clinical success rate 90% for the first 41 patients. One adverse event (2.4%) occurred, moderate in severity per the American Society of Gastrointestinal Endoscopy (ASGE) lexicon for adverse endoscopic events. In this study, we outlined the steps involved to establish a POEM service in a large integrated healthcare system. Prior competency in interventional endoscopy, procedural training models, POEM observation and education, proctorship, and interdisciplinary patient care are recommended.
Sections du résumé
BACKGROUND
Per Oral Endoscopic Myotomy (POEM) is a minimally invasive treatment for achalasia with results comparable to laparoscopic Heller myotomy (LHM). Studies have described the development of proficiency for endoscopists learning to perform POEM, and societies have defined educational and technical objectives for advanced endoscopy fellows in training. However, there is limited guidance on the organizational strategy and educational plan necessary to develop an achalasia service with POEM expertise.
AIMS
We aim to outline the steps for design and implementation of a successful POEM program.
METHODS
We reported our experience developing a multi-disciplinary clinical program for POEM and the steps taken to achieve procedural proficiency. We also reported our technical success (successful tunneling into the gastric cardia and myotomy of LES muscle fibers) and clinical success (post-procedure Eckardt score ≤ 3) at 3-6 months and 12 months post-procedure. Adverse events were classified per the ASGE lexicon for endoscopic adverse events.
RESULTS
After creating a multi-disciplinary clinical program for achalasia and completing procedural proficiency for POEM, our technical success rate was 100% and clinical success rate 90% for the first 41 patients. One adverse event (2.4%) occurred, moderate in severity per the American Society of Gastrointestinal Endoscopy (ASGE) lexicon for adverse endoscopic events.
CONCLUSION
In this study, we outlined the steps involved to establish a POEM service in a large integrated healthcare system. Prior competency in interventional endoscopy, procedural training models, POEM observation and education, proctorship, and interdisciplinary patient care are recommended.
Identifiants
pubmed: 36725765
doi: 10.1007/s10620-023-07839-y
pii: 10.1007/s10620-023-07839-y
pmc: PMC9891752
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
2276-2284Informations de copyright
© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Références
Patel DA, Lappas BM, Vaezi MF. An Overview of Achalasia and Its Subtypes. Gastroenterology & Hepatology 2017;13:411–421.
Francis DL, Katzka DA. Achalasia: Update on the disease and its treatment. Gastroenterology 2010;139:369–374.
doi: 10.1053/j.gastro.2010.06.024
pubmed: 20600038
Ghoshal UC, Daschakraborty SB, Singh R. Pathogenesis of achalasia cardia. World J Gastroenterol 2012;18:3050–3057.
doi: 10.3748/wjg.v18.i24.3050
pubmed: 22791940
pmcid: 3386318
Sadowski DC, Ackah F, Jiang B et al. Achalasia: Incidence, prevalence and survival. A population-based study. Neurogastroenterol Motil 2010;22:e256–e261.
doi: 10.1111/j.1365-2982.2010.01511.x
pubmed: 20465592
Khashab MA, Vela MF, Thosani N et al. ASGE guideline on the management of achalasia. Gastrointest Endosc 2020;91:213–227.
doi: 10.1016/j.gie.2019.04.231
pubmed: 31839408
Yadlapati R, Kahrilas PJ, Fox MR et al. Esophageal motility disorders on high-resolution manometry: Chicago classification version 4.0 ©. Neurogastroenterol Motil 2021;33:e14058.
doi: 10.1111/nmo.14058
pubmed: 33373111
pmcid: 8034247
Eckardt V, Aignherr C, Bernhard G. Predictors of outcome in patients with achalasia treated by pneumatic dilation. Gastroenterology 1992;103:1732–1738.
doi: 10.1016/0016-5085(92)91428-7
pubmed: 1451966
Inoue H, Minami H, Kobayashi Y et al. Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy 2010;42:265–271.
doi: 10.1055/s-0029-1244080
pubmed: 20354937
Inoue H. Kudo SE [Per-oral endoscopic myotomy (POEM) for 43 consecutive cases of esophageal achalasia]. Nippon rinsho Japanese J Clin Med 2010;68:1749–1752.
Werner Y, Hakanson B, Martinek J et al. Endoscopic or Surgical Myotomy in Patients with Idiopathic Achalasia. N Engl J Med 2019;381:2219–2229.
doi: 10.1056/NEJMoa1905380
pubmed: 31800987
Ponds F, Fockens P, Lei A et al. Effect of Peroral Endoscopic Myotomy vs Pneumatic Dilation on Symptom Severity and Treatment Outcomes Among Treatment-Naive Patients With Achalasia: A Randomized Clinical Trial. JAMA 2019;322:134–144.
doi: 10.1001/jama.2019.8859
pubmed: 31287522
pmcid: 6618792
Kumbhari V, Tieu A, Onimaru M et al. Peroral endoscopic myotomy (POEM) vs laparoscopic Heller myotomy (LHM) for the treatment of Type III achalasia in 75 patients: a multicenter comparative study. Endosc Int Open 2015;3:E195–E201.
doi: 10.1055/s-0034-1391668
pubmed: 26171430
pmcid: 4486039
Haito-Chavez Y, Inoue H, Beard KW et al. Comprehensive Analysis of Adverse Events Associated With Per Oral Endoscopic Myotomy in 1826 Patients: An International Multicenter Study. Am J Gastroenterol 2017;112:1267–1276.
doi: 10.1038/ajg.2017.139
pubmed: 28534521
Nabi Z, Reddy DN, Ramchandani M. Adverse events during and after per-oral endoscopic myotomy: prevention, diagnosis, and management. Gastrointest Endosc 2018;87:4–17.
doi: 10.1016/j.gie.2017.09.029
pubmed: 28987545
Faulx AL, Lightdale JR, Acosta RD et al. Guidelines for privileging, credentialing, and proctoring to perform GI endoscopy. Gastrointest Endosc 2017;85:273–281.
doi: 10.1016/j.gie.2016.10.036
pubmed: 28089029
Liu Z, Zhang X, Zhang W et al. Comprehensive Evaluation of the Learning Curve for Peroral Endoscopic Myotomy. Clin Gastroenterol Hepatol 2018;16:1420-1426.e2.
doi: 10.1016/j.cgh.2017.11.048
pubmed: 29208537
Houning L, Zhao N, Zheng Z et al. Analysis of the learning curve for peroral endoscopic myotomy for esophageal achalasia: Single-center, two-operator experience. Dig Endosc 2017;29:299–306.
doi: 10.1111/den.12763
Khashab MA. Thoughts on starting a peroral endoscopic myotomy program. Gastrointest Endosc 2013;77:109–110.
doi: 10.1016/j.gie.2012.10.017
pubmed: 23261100
El Zein M, Kumbhari V, Ngamruengphong S et al. Learning curve for peroral endoscopic myotomy. Endosc Int Open 2016;04:E577–E582.
doi: 10.1055/s-0042-104113
Munroe C, Lin T, Rouillard S et al. Influence of Telemedicine-first Intervention on Patient Visit Choice, Postvisit Care, and Patient Satisfaction in Gastroenterology. Gastroenterology 2021;160:929-931.e2.
doi: 10.1053/j.gastro.2020.10.020
pubmed: 33075348
Pannala R, Krishnan K, Watson RR et al. Devices for esophageal function testing. Gastrointest Endosc 2022;95:27–29.
doi: 10.1016/j.gie.2021.08.018
pubmed: 34696917
Zhang LY, Bejjani M, Ghandour B et al. Rethinking the need for overnight admission after peroral endoscopic myotomy (POEM): a pandemic-driven approach to the future. Endosc Int open 2021;9:E1381–E1385.
doi: 10.1055/a-1490-9385
pubmed: 34466362
pmcid: 8367444
Benias PC, Korrapati P, Raphael KL et al. Safety and feasibility of performing peroral endoscopic myotomy as an outpatient procedure with same-day discharge. Gastrointest Endosc 2019;90:570–578.
doi: 10.1016/j.gie.2019.04.247
pubmed: 31078571
Cotton PB, Eisen GM, Aabakken L et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 2010;71:446–454.
doi: 10.1016/j.gie.2009.10.027
pubmed: 20189503
Schlottmann F, Luckett DJ, Fine J et al. Laparoscopic Heller Myotomy Versus Peroral Endoscopic Myotomy (POEM) for Achalasia: A Systematic Review and Meta-analysis. Ann Surg 2018;267:451–460.
doi: 10.1097/SLA.0000000000002311
pubmed: 28549006
Dacha S, Aihara H, Anand GS et al. Core curriculum for peroral endoscopic myotomy (POEM). Gastrointest Endosc 2021;93:539–543.
doi: 10.1016/j.gie.2020.10.026
pubmed: 33422284