Michelle Savu, MD1, Ashish Sharma, MD2, Haruo Ikeda, MD2, Joshua Tuason, MD2, H Ominami2, K Kono, MD2, Haru Inoue, MD, PhD2. 1BJU, 2Showa University, Toyosu , Tokyo Japan
Introduction: Since its inception in 2008, POEM has become a viable procedure for the treatment of achalasia and esophageal dysmotility disorders. However many institutions are in the beginning stages of implementing the procedure into their programs. In view of training, we report the successful ability to dissect and identify common landmarks during a POEM procedure performed by trainees under supervision in a high volume POEM center.
Methods: 23 posterior POEM procedures performed by trainees with experienced proctor guidance during the period between February to July 2017 were evaluated for the frequency of identifying the 2 perforating vessels, the presence of sling fibers, and position on the lesser curvature of stomach evaluated by double scoping method during the creation of the tunnel and myotomy for procedure.
Results: All 23 POEM procedures were successfully completed by trainees (GI and surgery fellows). The average length of procedure was 79 minutes. Indication for procedure included 13 patients with Type 1 achalasia (56%), 9 with Type 2 achalasia (40%) and 1 DES (4%). Average length of myotomy for all procedures was 10.4 cm. During these procedures 1 or 2 perforator vessels were identified in 11 (48%) of patients, sling muscle was identified in 10 patients (43%) of patients. Myotomy extended to anterior lesser curvature of stomach on double scope exam in 100% of patients. No patient had a serious complication requiring intervention.
Conclusion: Trainees performing a posterior POEM procedure were able to correctly dissect and identify the sling muscle and/or perforating vessels in approximately 48% and 40% respectively of procedures. However the myotomy position was correctly placed in all procedures. This indicates that while ideally the sling fibers and perforating vessels should be identified, a correctly positioned myotomy can still be successfully performed by trainees without identification of these landmarks.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88530
Program Number: P378
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster