Abstract
Background and study aims Gastroenterology societies have recently proposed core curricula for training in
per-oral endoscopic myotomy (POEM) based on expert opinion with limited data on its
applicability for advanced endoscopy fellowship (AEF) trainees. We prospectively evaluated
the feasibility of a structured POEM training curriculum during a dedicated AEF and
the trainee’s performance during independent practice.
Methods This was a single-center prospective study evaluating a trainee’s performance of POEM
using a structured assessment tool (POEMAT) to assess core cognitive and technical
skills. The trainee’s performance was then prospectively assessed during the first
12 months of independent practice.
Results The trainee, who had not prior background in submucosal endoscopy, first observed
22 POEM cases followed by 35 hands-on procedures during his advanced endoscopy fellowship. Based
on the POEMAT, submucosal entry and mucosal incision closure were the most challenging
technical aspects, while cognitive skills were uniformly attained early in training.
Overall, the trainee was able to cross the threshold for competence in his POEMAT
performance score in 15 of his last 18 cases (83.3 %). The trainee performed 16 POEMs
(baseline mean Eckardt 7.2) in his first 12 months of independent practice. Mean procedural
time was 79.8 minutes (interquartile range: 67–94 minutes minutes) with no adverse
events. Clinical success (Eckardt score < 3) was achieved in 100 % of the cases at
a median follow-up of 20 weeks.
Conclusions Results from this pilot study support the adoptability of the recently proposed core
curricula for POEM training within the context of a dedicated AEF and provide a potential
blueprint for future studies of performance in POEM among trainees.
