Learning Curve and Initial Outcomes

Per-oral endoscopic myotomy (POEM) represents the prototype for successful natural orifice surgery; an incisionless, endoscopic approach combined with the precision of a surgical myotomy. Since the initial description by Haru Inoue of the procedure in 2008 and publication of his initial results in 2010 (Inoue et al., Endoscopy 42:265–271, 2010), POEM has been adopted at high-volume esophageal centers around the world. The procedure is being performed by both surgical endoscopists and interventional gastroenterologists. This chapter reviews the characteristics and initial experience of early POEM operators and the existing literature regarding learning curves for the procedure. The growing use of the functional lumen imaging probe for intraoperative physiologic measurements is also discussed, specifically focusing on the dual role as both a quality-control indicator and a potential tool to guide new POEM operators during the learning curve.

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