Analysis of the learning curve for peroral endoscopic myotomy for esophageal achalasia: Single‐center, two‐operator experience

Objectives Peroral endoscopic myotomy (POEM) has emerged as an advanced technique for the treatment of achalasia, and defining the learning curve is mandatory. Methods From August 2011 to June 2014, two operators in our institution (A&B) have performed POEM on 35 and 33 consecutive patients, respectively. The moving average and cumulative sum (CUSUM) methods were employed to analyze the POEM learning curve for corrected operative time (cOT), referring to duration of per centimeter myotomy. Additionally, perioperative outcomes were compared among distinct learning curve phases. Results Using the moving average method, cOT reached a plateau at the 29th case and 24th case for operator A and B, respectively. The CUSUM analysis identified three phases: initial learning period (Phase1), efficiency period (Phase 2) and mastery period (Phase3). The relatively smooth state in CUSUM graph occurred at the 26th case and 24th case for operator A and B, respectively. The mean cOT of distinct phases for operator A was 8.32, 5.20 and 3.97 minutes, while being 5.99, 3.06 and 3.75 minutes for operator B, respectively. The Eckardt score and lower esophageal sphincter pressure has significantly decreased during the 1-year follow-up period. Data were comparable regarding patient characteristics and perioperative outcomes. Conclusions This single center study demonstrated that expert endoscopists with experience in esophageal endoscopic submucosal dissection reached a plateau in learning of POEM after around 25 cases. This article is protected by copyright. All rights reserved.