When is POEM truly equivalent to LHM? A comparison of complication rates during the learning curve

Introduction Per-Oral Endoscopic Myotomy (POEM) is an effective treatment for Esophageal Achalasia Cardia (EAC) but the endoscopic technique required is complex. As competency is crucial for patient safety, we believe that its' competency can be demonstrated when the complication rate equals th...

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Main Authors: Wong, Wei Jin, Affendi, Nik Arsyad Nik Muhamad, Li Siow, Sze, Mahendran, Hans Alexander, Lau, Peng Choong, Ho, Shiaw Hooi, Mahadeva, Sanjiv
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Published: SPRINGER 2023
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Online Access:http://eprints.um.edu.my/39404/
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spelling my.um.eprints.394042024-11-27T06:41:44Z http://eprints.um.edu.my/39404/ When is POEM truly equivalent to LHM? A comparison of complication rates during the learning curve Wong, Wei Jin Affendi, Nik Arsyad Nik Muhamad Li Siow, Sze Mahendran, Hans Alexander Lau, Peng Choong Ho, Shiaw Hooi Mahadeva, Sanjiv RD Surgery Introduction Per-Oral Endoscopic Myotomy (POEM) is an effective treatment for Esophageal Achalasia Cardia (EAC) but the endoscopic technique required is complex. As competency is crucial for patient safety, we believe that its' competency can be demonstrated when the complication rate equals that of an established procedure such as Laparoscopic Heller's Myotomy with Fundoplication (LHM + F). Methods A multicentre, ambi-directional, non-randomized comparison of intra-procedural complications during the learning curve of POEM was performed against a historical cohort of LHM + F. Demographic, clinicopathological, procedural data and complications were collected. A direct head-to-head comparison was performed, followed by a population pyramid of complication frequency. Case sequence was then divided into blocks of 5, and the complication rates during each block was compared to the historical cohort. Results From January 2010 to April 2021, 60 patients underwent LHM + F and 63 underwent POEM. Mean age was lower for the POEM group (41.7 years vs 48.1 years, p = 0.03), but there was no difference in gender nor type of Achalasia. The POEM group recorded a shorter overall procedural time (125.9 min vs 144.1 min, p = 0.023) and longer myotomies (10.1 cm vs 6.2 cm, p = 0.023). The overall complication rate of POEM was 20.6%, whereas the historical cohort of LHM + F had a rate of 10.0%. On visual inspection of the population pyramid, complications were more frequent in the earlier procedures. On block sequencing, complication frequency could be seen tapering off dramatically after the 25th case, and subsequently equalled that of LHM + F. Conclusion POEM is challenging even for experienced endoscopists. From our data, complication rates between POEM and LHM + F equalize after approximately 25 POEMs. SPRINGER 2023-03 Article PeerReviewed Wong, Wei Jin and Affendi, Nik Arsyad Nik Muhamad and Li Siow, Sze and Mahendran, Hans Alexander and Lau, Peng Choong and Ho, Shiaw Hooi and Mahadeva, Sanjiv (2023) When is POEM truly equivalent to LHM? A comparison of complication rates during the learning curve. Surgical Endoscopy and Other Interventional Techniques, 37 (3). pp. 1735-1741. ISSN 0930-2794,
institution Universiti Malaya
building UM Library
collection Institutional Repository
continent Asia
country Malaysia
content_provider Universiti Malaya
content_source UM Research Repository
url_provider http://eprints.um.edu.my/
topic RD Surgery
spellingShingle RD Surgery
Wong, Wei Jin
Affendi, Nik Arsyad Nik Muhamad
Li Siow, Sze
Mahendran, Hans Alexander
Lau, Peng Choong
Ho, Shiaw Hooi
Mahadeva, Sanjiv
When is POEM truly equivalent to LHM? A comparison of complication rates during the learning curve
description Introduction Per-Oral Endoscopic Myotomy (POEM) is an effective treatment for Esophageal Achalasia Cardia (EAC) but the endoscopic technique required is complex. As competency is crucial for patient safety, we believe that its' competency can be demonstrated when the complication rate equals that of an established procedure such as Laparoscopic Heller's Myotomy with Fundoplication (LHM + F). Methods A multicentre, ambi-directional, non-randomized comparison of intra-procedural complications during the learning curve of POEM was performed against a historical cohort of LHM + F. Demographic, clinicopathological, procedural data and complications were collected. A direct head-to-head comparison was performed, followed by a population pyramid of complication frequency. Case sequence was then divided into blocks of 5, and the complication rates during each block was compared to the historical cohort. Results From January 2010 to April 2021, 60 patients underwent LHM + F and 63 underwent POEM. Mean age was lower for the POEM group (41.7 years vs 48.1 years, p = 0.03), but there was no difference in gender nor type of Achalasia. The POEM group recorded a shorter overall procedural time (125.9 min vs 144.1 min, p = 0.023) and longer myotomies (10.1 cm vs 6.2 cm, p = 0.023). The overall complication rate of POEM was 20.6%, whereas the historical cohort of LHM + F had a rate of 10.0%. On visual inspection of the population pyramid, complications were more frequent in the earlier procedures. On block sequencing, complication frequency could be seen tapering off dramatically after the 25th case, and subsequently equalled that of LHM + F. Conclusion POEM is challenging even for experienced endoscopists. From our data, complication rates between POEM and LHM + F equalize after approximately 25 POEMs.
format Article
author Wong, Wei Jin
Affendi, Nik Arsyad Nik Muhamad
Li Siow, Sze
Mahendran, Hans Alexander
Lau, Peng Choong
Ho, Shiaw Hooi
Mahadeva, Sanjiv
author_facet Wong, Wei Jin
Affendi, Nik Arsyad Nik Muhamad
Li Siow, Sze
Mahendran, Hans Alexander
Lau, Peng Choong
Ho, Shiaw Hooi
Mahadeva, Sanjiv
author_sort Wong, Wei Jin
title When is POEM truly equivalent to LHM? A comparison of complication rates during the learning curve
title_short When is POEM truly equivalent to LHM? A comparison of complication rates during the learning curve
title_full When is POEM truly equivalent to LHM? A comparison of complication rates during the learning curve
title_fullStr When is POEM truly equivalent to LHM? A comparison of complication rates during the learning curve
title_full_unstemmed When is POEM truly equivalent to LHM? A comparison of complication rates during the learning curve
title_sort when is poem truly equivalent to lhm? a comparison of complication rates during the learning curve
publisher SPRINGER
publishDate 2023
url http://eprints.um.edu.my/39404/
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