ArticleSurgical endoscopy2026
The learning curve for peroral endoscopic myotomy in a tertiary center of China.
Article in Surgical endoscopy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundAchalasia is a rare esophageal motility disorder marked by impaired lower esophageal sphincter relaxation. Peroral endoscopic myotomy (POEM) has become a first-line therapy owing to its minimally invasive approach and proven efficacy. This study aimed to define the POEM learning curve for experienced endoscopists at a tertiary Chinese medical center.
methodsWe retrospectively reviewed 168 POEM procedures performed between 2015 and 2021 by three endoscopists, each with experience in > 100 endoscopic submucosal dissections (ESD) cases and trainings on three animal-model. Cumulative sum (CUSUM) analysis of procedure time was the primary measure. Secondary outcomes included complications, length of hospital stay, and 3-year clinical success rate (Eckardt score ≤ 3).
resultsLearning curve inflection points occurred at 15-20 cases, after which procedure time decreased significantly (94.9 ± 27.4 vs. 55.5 ± 15.5 min, p < 0.001). Complication rates were stable (competence phase: 19.6% vs. proficiency phase: 17.1%, p = 0.70), while hospital stay was shorter in the proficiency phase (7.6 ± 2.5 vs. 6.6 ± 2.0 days, p = 0.009). Both phases achieved high 3-year success rates (90% vs. 95%, p = 0.563), consistent with published benchmarks.
conclusionsFor endoscopists with prior ESD expertise, POEM proficiency can be achieved after 15-20 cases, with safety and efficacy maintained throughout training. Shorter hospital stays in the proficiency phase likely reflect improvements in perioperative management.
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