Impact of Focused Hands-on Training Course on Practice Adoption of Advanced Endoscopic Techniques and Per-Oral Endoscopic Myotomy.

Abstract

Background: Per-oral endoscopic myotomy (POEM) is a valuable tool for the treatment of foregut motility disorders. Hands-on courses are often utilized at the initial means of training in POEM. Whether such training is sufficient to allow individuals to launch an independent practice in POEM is unknown. The purpose of this study was to evaluate the successes and barriers of implementing a POEM practice after attending a hands-on course. Methods: We evaluated participants of a 2-day focused POEM training course. All participants of the course were sent a survey to assess their endoscopic practice before and after the course, concentrating on their ability to implement POEM after returning to their home institution. Results: Between 2012 and 2017, 11 POEM courses were held at our institution, with a total of 102 trainees. Fifty-five individuals responded to our survey (53.9%), most of whom were general surgeons who were already doing some therapeutic endoscopy but had not previously performed POEM. More than half (58.2%) were able to institute a POEM practice at their home institution after the course. Those that were successful in starting a POEM practice were more often those with previous advanced endoscopic experience (90.3%). Success was assisted by high rates of additional explant laboratories (43.6%) and in-person proctoring (52.4%) after completing the course. Those that did not start a POEM practice sited lack of institutional support as the main barrier, followed by problems with insurance approval, and lack of referral volume. Conclusion: Despite the complexity of the POEM procedure, a focused hands-on POEM training course is associated with a high rate of implementation of an independent POEM practice, particularly in individuals with previous advanced endoscopic experience. The largest barriers to POEM adoption are not technical factors, but rather are related to institutional and insurance factors.