S0346 Prospective Pilot Study Evaluating Training in Per-Oral Endoscopic Myotomy (POEM) Using a Standardized Assessment Tool (STAT)

Abstract

INTRODUCTION: In light of the increasing number of advanced endoscopy trainees (AETs) performing peroral endoscopic myotomy (POEM), standardization of competence assessment in POEM training is necessary. The aim of this pilot study was to develop a standardized assessment tool (STAT) to evaluate important cognitive and technical skills during POEM training. METHODS: Prospective single center pilot study evaluating advanced endoscopy trainee’s (AET) performance in POEM using the STAT. The tool was first designed by consensus opinion among expert POEM endoscopists, review of the literature and standardization to include key cognitive and technical skills (Figure 1). A 4-point scoring system was used to grade each endpoint. Global rating was provided using a 10-point scoring system. For pilot data analysis, competence was defined as a score of 3 or 4 for each endpoint and ≥7 for overall assessment. RESULTS: The AET’s POEM training was evaluated between July 2018 to Nov 2019. At baseline, the AET had cognitive and ex-vivo animal hands-on training (case volume 6) in POEM. During the first phase of his training in humans, the AET observed 22 cases performed by expert endoscopists followed by supervised limited hands-on participation in cases 23 through 40. The STAT was then introduced and used to evaluate his performance between cases 41 through 53. Competence in cognitive skills, such as identification of esophageal wall layers and the gastroesophageal junction during POEM, was achieved in 91.6% and 75% of the cases, respectively. From a technical standpoint, the AET demonstrated competence (score of ≥3) for all hands-on submucosal tunneling and myotomies during POEM cases 41 through 53. Conversely, both mucosal incision at the beginning of POEM and incision closure at the end of the procedure were technically more challenging, with the AET being graded as competent in only 63.6% and 66.6% of the cases, respectively. Overall competence in POEM (based on global rating) was attained in 83.3% of the cases. All POEM cases were successfully completed and there were no adverse events. CONCLUSION: Standardized evaluation of competence in POEM training is critical for quality assurance in patient care. Using the STAT, this pilot data demonstrated how competence is variable across different endpoints, and allows specific targeted feedback and monitoring of performance in various parameters. The POEM-STAT is currently being validated through an ongoing multicenter prospective trial.Figure 1.: Per Oral Endoscopic Myotomy Training Assessment Tool.