TRAINING IN PERORAL ENDOSCOPIC MYOTOMY IN AN ANIMAL MODEL

Aims:

Per oral endoscopic myotomy (POEM) is an effective treatment for achalasia. It is technically challenging and some authors advocate for preclinical training. However, there is a lack of data regarding the type of training needed and the previous expertise required.

We aimed to evaluate if training in an animal model could provide the necessary skills to perform POEM safely and effectively.

Tab. 1:

ADVERSE EVENTS

RESULTS	TOTAL (N = 15)	GROUP A (N = 7)	GROUP B (N = 8)
Bleeding (%)	33	57	12	P = 0,07
Mucosotomy (%)	13	14	12	P > 0.05
AIR RELATED (%) Pneumoperitoneum/Pneumomediastinum	40/53	57/71	25/37	P > 0.05
AND DEATH	33	57	12	P = 0.07

Methods:

A single endoscopist performed POEM in swine live models from March 2017 to June 2018 following the standard technique, except for the use of air instead of CO2 to insufflate.

All total procedure time, creation of mucosal entry, creation of submucosal tunnel and myotomy were measured, as well as length of myotomy and length of mucosal entry. Adverse events (AE) rates were calculated: mucosotomy, pnemomediastin, pneumoperitoneum, bleeding or death.

We compared the results from a first subset of cases (group A, N = 7) with a second one (group B, N = 8) to assess our progression.

Results:

Table 1. Fifteen POEM were performed. We found no differences in procedural time and myotomy length between groups. Table 1 shows AE rates in global and in both groups.

Conclusions:

Swine live model allowed POEM training. AE during first cases are common. Bleeding in swine model is mild. Air related AE were the most common and severe complications, probably because CO2 was not used. After the first seven cases, the AE tended to diminish.