Sa1278 THIRD SPACE ENDOSCOPY AFTER FORMAL ENDOSCOPY ADVANCED FELLOWSHIP TRAINING IN THE US: IS IT TIME FOR ESTABLISHED TRAINING?

Abstract

Third space endoscopy includes peroral endoscopic myotomy (POEM) and gastric peroral endoscopic pyloromyotomy (GPOEM). The majority of advanced endoscopy fellowships offer training focused on ERCP and EUS. Very few advanced endoscopy fellowships offer comprehensive training in third space endoscopy in addition to ERCP and EUS given the risk associated with these procedures and the limited US expertise. Multiple studies have reported the learning curve without formal training, which in general suggest procedure certain procedure times, adverse events, clinical and technical failure. We examine the single academic center initial experience following formal third space endoscopy training. We analyzed the number of cases of third space endoscopy cases performed in one-year training and calculated the learning curve. Then we followed up the data of the procedure that was performed by the same formal trainee after practicing independently in a tertiary referral center. Video recording of all procedure was available for review by expert attendings. The trainee performed 89 POEM and GPOEM during the one-year training program under the direct supervision of an expert attending. Step by step training was programed: endoscopic tunneling and closure was followed shortly by endoscopic myotomy. The limited endoscopic incision was the final learning step. Attending-level competency was achieved after 50 procedures. In initial academic practice, 20 procedures (15 POEM, 5 GPOEM) were performed. The average procedure time for POEM and GPOEM was 40 ± 14 minutes. Average pre-procedure Eckardt score of 8 decreased to 1 following poem. Technical and short term clinical success was achieved in all cases. There were no adverse events. An average of 3 endoclips were used to close the POEM incision. Post-procedure hospital stay was one day for 18 patients and 2 days for two patients. Our initial results suggest that formal training in third space endoscopy yields excellent outcomes in the transition to academic practice, with an estimated 50 cases of direct expert supervision needed to achieve competency in these procedures. This experience may be helpful in the design of training and certification programs.