拉丁美洲经口内镜下肌切开术的学习曲线：是否向右偏移？
The Learning Curve for Peroral Endoscopic Myotomy in Latin America: A Slide to the Right?
作者信息
Kahaleh Michel, Tyberg Amy, Suresh Supriya, Lambroza Arnon, Casas Fernando Rodriguez, Rey Mario, Nieto Jose, Martínez Guadalupe Ma, Zamarripa Felipe, Arantes Vitor, Porfilio Maria G, Gaidhane Monica, Familiari Pietro, Carames Juan Carlos, Vargas-Rubio Romulo, Canadas Raul, Hani Albis, Munoz Guillermo, Castillo Bismarck, Moura Eduardo T, Galileu Farias F, Lukashok Hannah P, Robles-Medranda Carlos, Moura Eduardo G de
机构信息
Robert Wood Johnson University Hospital, New Brunswick, NJ, USA.
Weill Cornell Medical College, New York, NY, USA.
出版信息
Clin Endosc. 2021 Sep;54(5):701-705. doi: 10.5946/ce.2020.290. Epub 2021 Jun 3.
BACKGROUND/AIMS: Peroral endoscopic myotomy (POEM) has been increasingly used for achalasia in Latin America, where Chagas disease is prevalent, and this makes POEM more challenging. The aim of this study was to determine the learning curve for POEM in Latin America.
METHODS
Patients undergoing POEM in Latin America with a single operator were included from a prospective registry over 4 years. Non-linear regression and cumulative sum control chart (CUSUM) analyses were conducted for the learning curve.
RESULTS
A total of 125 patients were included (52% male; mean age, 59 years), of which 80 had type II achalasia (64%), and 38 had Chagas disease (30%). The average pre-procedure and post-procedure Eckardt scores were 6.79 and 1.87, respectively. Technical success was achieved in 93.5% of patients, and clinical success was achieved in 88.8%. Adverse events occurred in 27 patients (22%) and included bleeding (4 patients), pneumothorax (4 patients), mucosal perforation (13 patients), mediastinitis (2 patients), and leakage (4 patients).
The CUSUM chart showed a median procedure time of 97 min (range, 45-196 min), which was achieved at the 61st procedure. Procedure duration progressively decreased, with the last 10 procedures under 50 min approaching a plateau (p-value <0.01).
CONCLUSION
Mastering POEM in Latin America requires approximately 61 procedures for both POEM efficiency and to accomplish the procedure within 97 minutes.
背景/目的：经口内镜下肌切开术（POEM）在拉丁美洲用于治疗贲门失弛缓症的应用日益增多，而该地区恰加斯病流行，这使得POEM手术更具挑战性。本研究的目的是确定拉丁美洲POEM手术的学习曲线。
方法
从一个前瞻性登记处纳入拉丁美洲4年间由单一术者进行POEM手术的患者。对学习曲线进行非线性回归和累积和控制图（CUSUM）分析。
结果
共纳入125例患者（52%为男性；平均年龄59岁），其中80例为Ⅱ型贲门失弛缓症（64%），38例患有恰加斯病（30%）。术前和术后埃卡德特评分的平均值分别为6.79和1.87。93.5%的患者获得技术成功，88.8%的患者获得临床成功。27例患者（22%）发生不良事件，包括出血（4例）、气胸（4例）、黏膜穿孔（13例）、纵隔炎（2例）和渗漏（4例）。CUSUM图显示手术时间中位数为97分钟（范围45 - 196分钟），在第61例手术时达到该时间。手术持续时间逐渐缩短，最后10例手术在50分钟以内，接近平稳期（p值<0.01）。
结论
在拉丁美洲掌握POEM手术，为提高手术效率并在97分钟内完成手术，大约需要61例手术。
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