Implementation of a peroral endoscopic myotomy program

  1. Pablo Miranda García 1
  2. Raquel Muñoz González 1
  3. José Carlos Marín Gabriel 2
  4. Eduardo Albéniz Arbizu 3
  5. Sergio Casabona Francés 1
  6. María Teresa Pérez Fernández 1
  7. Montserrat Grau Bono 2
  8. Cecilio Santander Vaquero 1
  1. 1 Hospital Universitario de La Princesa. Madrid, Spain
  2. 2 Hospital Universitario 12 de Octubre. Madrid, Spain
  3. 3 Complejo Hospitalario de Navarra. Navarra, Spain
Revista:
Revista Española de Enfermedades Digestivas

ISSN: 2340-416 1130-0108

Año de publicación: 2021

Volumen: 113

Número: 5

Páginas: 339-344

Tipo: Artículo

DOI: 10.17235/REED.2020.7116/2020 DIALNET GOOGLE SCHOLAR

Otras publicaciones en: Revista Española de Enfermedades Digestivas

Objetivos de desarrollo sostenible

Resumen

Introduction: the aim of our study was to develop a peroral endoscopic myotomy (POEM) program in our Unit following a two-step sequence: training on animal models and supervision by an experienced endoscopist during the first human cases. Methods: a single endoscopist experienced in advanced endoscopy was trained in POEM. After observing POEM in referral centers, training was implemented on swine models (preclinical phase). Technical aspects and adverse events were prospectively recorded. A first subset of cases (group A) was compared to a second one (group B) to assess our progression. Finally, POEM was implemented in humans under the supervision of an experienced endoscopist (clinical phase). The outcomes and adverse events were prospectively recorded. Results: during the preclinical phase, 15 POEM procedures were performed on live pigs. Severe adverse events (AE) were less frequent in group B than in group A (12 % vs 57 %, p = 0.07). After nine cases, a plateau of adverse events was reached. During the clinical phase, eleven POEM procedures were performed in patients under expert supervision. Technical and clinical (Eckardt score ≤ 3) success were 100 % and 91 %, respectively (follow-up 3-21 months). In two cases, intervention of an experienced endoscopist was required (cases 2 and 3) because of a difficult orientation at the esophagogastric junction. One mild pneumoperitoneum occurred, with no severe adverse events reported. Conclusions: training in animal models and supervision by an experienced endoscopist during the first cases could provide the necessary skills to perform POEM safely and effectively.