Department of Internal Medicine, Kaiser Permanente San Francisco, San Francisco, CA, USA.
Department of Gastroenterology, Kaiser Permanente San Jose, San Jose, CA, USA.
Dig Dis Sci. 2023 Jun;68(6):2276-2284. doi: 10.1007/s10620-023-07839-y. Epub 2023 Feb 1.
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.
经口内镜下肌切开术（POEM）是治疗贲门失弛缓症的一种微创治疗方法，其效果可与腹腔镜 Heller 肌切开术（LHM）相媲美。已经有研究描述了内镜医生学习进行 POEM 的熟练程度的发展，并且学会已经为接受培训的高级内镜研究员定义了教育和技术目标。然而，对于开发具有 POEM 专业知识的贲门失弛缓症服务所需的组织策略和教育计划，指导有限。
我们旨在概述设计和实施成功的 POEM 计划的步骤。
我们报告了我们在开发用于 POEM 的多学科临床计划以及为实现程序熟练程度而采取的步骤方面的经验。我们还报告了我们在 3-6 个月和 12 个月后进行程序的技术成功率（成功进入胃贲门隧道和切开 LES 肌肉纤维）和临床成功率（术后 Eckardt 评分≤3）。内镜不良事件按美国胃肠内镜学会（ASGE）内镜不良事件词汇表进行分类。
在为贲门失弛缓症创建多学科临床计划并完成 POEM 的程序熟练程度后，我们的前 41 名患者的技术成功率为 100%，临床成功率为 90%。发生了 1 例不良事件（2.4%），根据 ASGE 内镜不良事件词汇表，其严重程度为中度。
在这项研究中，我们概述了在大型综合医疗保健系统中建立 POEM 服务所涉及的步骤。建议在介入内镜、程序培训模型、POEM 观察和教育、指导和跨学科患者护理方面具有先前的能力。
